Journal articles on the topic 'Suture age'
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Boyajian, Michael K., Hanny Al-Samkari, Dennis C. Nguyen, Sybill Naidoo, and Albert S. Woo. "Partial Suture Fusion in Nonsyndromic Single-Suture Craniosynostosis." Cleft Palate-Craniofacial Journal 57, no. 4 (February 4, 2020): 499–505. http://dx.doi.org/10.1177/1055665620902299.
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Introduction: Partial synostosis of cranial sutures has been shown to have clinical and diagnostic significance. However, there is limited published information about how suture fusion progresses over time. In this study, we evaluate patients with nonsyndromic single-suture synostosis. We aim to define the incidence of partial versus complete suture fusion and whether a correlation exists between the degree of suture fusion and age. Methods: Two hundred fifty-four patients with nonsyndromic single-suture synostosis were evaluated. Preoperative computed tomography (CT) scans were rendered in 3-dimensions, all sutures were visualized and assessed for patency or fusion, and length of fusion was measured. Findings were grouped according to suture type (sagittal, coronal, metopic, or lambdoid), the degree of fusion (full, >50%, or <50%), and patient age at time of CT scan (0-90, 91-180, 181-360, or >360 days). Data were analyzed to correlate patient age versus the degree of suture fusion. Results: For all patients, 72% had complete and 28% had partial synostosis. Ratios of full to partial fusion for each suture type were as follows: sagittal 97:36, coronal 35:22, metopic 46:4, and lambdoid 4:10. The sagittal, coronal, and metopic groups demonstrated greater probabilities of complete suture fusion as patient age increases ( P = .021, P < .001, P = .001, respectively). This trend was also noted when all sutures were considered together by age-group ( P < .001). Conclusion: We note a partial suture fusion rate of 28.3%. Our analysis shows a correlation between the extent of suture synostosis and patient age. Finally, we demonstrate that different sutures display different patterns of partial and complete fusion.
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V., Shashikala, Abhilash S. B., Abhishek G., and Prajwal S. Fernandes. "A comparative study between continuous and x-interrupted sutures in emergency midline laparotomies." International Surgery Journal 5, no. 5 (April 21, 2018): 1753. http://dx.doi.org/10.18203/2349-2902.isj20181437.
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Background: Midline laparotomy is the most common technique of abdominal incisions in both emergency and elective settings. Wound dehiscence is related to several factors pertaining to patient besides suture material and method of closure. This study tries to compare continuous sutures with x-interrupted sutures in mass closure of midline laparotomy wound in patients undergoing emergency midline laparotomy for acute peritonitis.Methods: A total of 60 patients undergoing emergency midline laparotomy for secondary peritonitis were considered for the study, 30 of whom underwent closure of abdominal wall with continuous sutures (Group A) and the other 30 with x-interrupted sutures (Group B) using non-absorbable, monofilament, polypropylene suture. Necessary preoperative data, the time required for rectus closure, length of the suture material required, post-operative complications like surgical site infection, wound dehiscence were analyzed.Results: The groups were comparable in means of age and sex distribution. Group A was found to have lesser time for closure of rectus, lesser suture length and lesser suture to wound length ratio when compared with Group B. Surgical site infections were similar in both groups. Patients with rectus sheath sutured in x-interrupted sutures (n=2) had significantly less wound dehiscence as compared with continuous sutures (n=8) (p<0.05).Conclusions: Interrupted -X suture method of suturing reduces post-operative wound dehiscence, although requires more suture and consumes more time than the continuous method of suturing.
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Mahakkanukrauh, Pasuk. "Age Estimation from Computed Tomography of Cranial Suture Closure in a Thai Population." Medicine & Health 15, no. 2 (December 31, 2020): 276–89. http://dx.doi.org/10.17576/mh.2020.1502.24.
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Age estimation from human skeletal remains is an important step to reconstruct a biological profile. Cranial suture has long been studied for its age-related closure. However, until now, forensic anthropologists still attempt to investigate the best way of estimating age at death from cranial suture closure because skull is usually found at the crime scene due to its easy recognised-appearance and persistence to post-mortem insults. For these reasons, a study of age estimation from cranial suture closure in a Thai population was conducted, which focussed to study the appearance and visibility of facial suture closure using computed tomography (CT). CT image series of 140 cases were obtained in order to investigate ectocranial closure of the selected facial sutures. The results from CT image analysis revealed that nasomaxillary provided the most consistent examination of suture closure (52%) while frontonasal delivered the lowest consistency in suture closure examination (29%). The inconsistency mostly occurred in assigning the closure score of 1 and 2. Thus, it could be suggested that a 3-scale scoring system of closure: open, closing, and closed, could be an appropriate method of evaluating degree of ectocranial closure of facial sutures obtained from CT imaging. This fundamental information of facial suture closure from CT images could serve as a starting point on development of age estimation technique from suture closure by utilising CT images.
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Keshav Tumram, Nilesh, Soniya B.Parchake, Arun P. Kasote, and Meena M. Meshram. "Macroscopic Cranial Suture Closure in An Adult Population: Is It Reliable for Estimating Age?" 99 3, no. 1 (June 1, 2021): 17–30. http://dx.doi.org/10.26735/ijjm2816.
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Background:- Age estimation is one of the important parameters for estimation of biological profile of an individual. Generally speaking, estimation of age of an individual whether living or dead is very important in Medicolegal and forensic scenario. The objective of the present study was to observe the chronology and pattern of union of cranial sutures namely coronal and lambdoid and to find out the relationship between closure of cranial suture and age of the deceased. An attempt was also made to see the applicability of Acsadi and Nemeskeri method in an Indian population. A total of 193 adult calvaria (133 males and 60 females) were studied from the autopsy cases. The extent of obliteration was studied ectocranially and endocranially in the two main sutures of the calvarium i.e. coronal and lambdoid. Results:- The results indicate that a strong positive correlation of ectocranial with endocranial suture closure is found in the age group of 30-39 years for right coronal, left coronal, while age group of 60-69 years shows a strong positive correlation for lambdoid sutures. This has also been confirmed in the study that the cranial suture obliteration starts endocranially and proceeds towards ectocranial surface. Statistically insignificant sex differences exist in suture closure. Conclusion:- The coronal and lambdoid sutures were closed in the age group of above 70 years with mean values of 3.54 for coronal and 3.7 for lambdoid suture. Acsadi and Nemeskeri’s method was found to be applicable to the Indian population for determination of age from cranial sutures.
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Hudgins, Roger J., Steven R. Cohen, Fernando D. Burstein, and William R. Boydston. "Multiple Suture Synostosis and Increased Intracranial Pressure following Repair of Single Suture, Nonsyndromal Craniosynostosis." Cleft Palate-Craniofacial Journal 35, no. 2 (March 1998): 167–72. http://dx.doi.org/10.1597/1545-1569_1998_035_0167_mssaii_2.3.co_2.
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Objective Increased intracranial pressure, frequently associated with closure of multiple cranial sutures, has been reported to occur in 36% of cases following correction of syndromal craniosynostosis. Although much less common, multiple suture closure may occur following repair of single suture, non-syndromal craniosynostosis and we present cases that concern two such children. Results Two children with nonsyndromal craniosynostosis, one metopic and one left-coronal, underwent fronto-orbital advancement at age 3 months. At age 19 months and at age 5 years, respectively, both patients re-presented with headaches, decrease in head circumference percentile, and acceptable cosmetic outcome. Both had computerized tomographic evidence of multiple closed cranial sutures and increased intracranial pressure (ICP) (determined by monitoring). Both patients improved following a cranial expansion procedure. Conclusion Delayed closure of multiple sutures and resultant increased ICP may occur following correction of nonsyndromal, single suture craniosynos-tosis. This may be more likely when the initial suture is contiguous with the facial sutures. Children should be followed for many years following cranio-synostosis repair with cranial, neurologic, and possibly funduscopic examinations as well as head circumference measurements to detect delayed closure of cranial sutures.
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Bausili Portabella, Maria Montserrat, Jeroni Nadal, Juan Alvarez de Toledo, María Fideliz de la Paz, and Rafael Ignacio Barraquer. "Long-term outcome of scleral-sutured posterior chamber intraocular lens: a case series." British Journal of Ophthalmology 104, no. 5 (August 21, 2019): 712–17. http://dx.doi.org/10.1136/bjophthalmol-2019-314054.
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PurposePurpose: To evaluate the long-term stability of scleral-sutured intraocular lenses (IOLs) and analyse the possible causes of suture breakage.SettingBarraquer Institute in Barcelona, Spain.DesignRetrospective study of consecutive cases.MethodsStudy of patients with scleral-sutured IOL with aphakia, subluxated or luxated IOL were included. Follow-up was longer than 6 months and patients over 18 years of age. Preoperative data (best-corrected visual acuity testing (BCVA), intraocular pressure (IOP), axial length and slit-lamp examination), intraoperative data (characteristics of the scleral flaps, suture material (Prolene or Mersilene) and scleral-sutured IOL) and postoperative data (BCVA, IOP, slit-lamp examination and complications) through 10 years were collected for analysis.Results345 consecutive cases of scleral-sutured IOL were included. 25 eyes underwent a second operation after a prior sutured IOL due to suture breakage (mean 40.2±39.6 months after the first surgery) and three of them needed a third surgery. Younger adults (less than 40-year old), the use of a combination of Prolene and Mersilene sutures to perform the surgery and suturing only one flap were found to have higher risk of suture breakage after a follow-up of 10 years. The probability of surviving of the scleral-sutured IOL at 10 years after surgery was 0.79.ConclusionsScleral-sutured posterior chamber IOL in eyes with a lack of capsular support is a safe and effective procedure with a low rate of complication and stable visual acuity. Further studies with special focus on young adults or myopic eyes are required to demonstrate long-term safety in those special cases.
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Wilkinson, C. Corbett, Cesar A. Serrano, Brooke M. French, Sarah J. Graber, Emily Schmidt-Beuchat, Lígia Batista-Silverman, Noah P. Hubbell, and Nicholas V. Stence. "Fusion patterns of minor lateral calvarial sutures on volume-rendered CT reconstructions." Journal of Neurosurgery: Pediatrics 26, no. 2 (August 2020): 200–210. http://dx.doi.org/10.3171/2020.2.peds1952.
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OBJECTIVESeveral years ago, the authors treated an infant with sagittal and bilateral parietomastoid suture fusion. This made them curious about the normal course of fusion of “minor” lateral sutures (sphenoparietal, squamosal, parietomastoid). Accordingly, they investigated fusion of these sutures on 3D volume-rendered head CT reconstructions in a series of pediatric trauma patients.METHODSThe authors reviewed all volume-rendered head CT reconstructions obtained from 2010 through mid-2012 at Children’s Hospital Colorado in trauma patients aged 0–21 years. Each sphenoparietal, squamosal, and parietomastoid suture was graded as open, partially fused, or fused. In several individuals, one or more lateral sutures were fused atypically. In these patients, the cephalic index (CI) and cranial vault asymmetry index (CVAI) were calculated. In a separately reported study utilizing the same reconstructions, 21 subjects had fusion of the sagittal suture. Minor lateral sutures were assessed, including these 21 individuals, excluding them, and considering them as a separate subgroup.RESULTSAfter exclusions, 331 scans were reviewed. Typically, the earliest length of the minor lateral sutures to begin fusion was the anterior squamosal suture, often by 2 years of age. The next suture to begin fusion—and first to complete it—was the sphenoparietal. The last suture to begin and complete fusion was the parietomastoid. Six subjects (1.8%) had posterior (without anterior) fusion of one or more squamosal sutures. Six subjects (1.8%) had fusion or near-complete fusion of one squamosal and/or parietomastoid suture when the corresponding opposite suture was open or nearly open. The mean CI and CVAI values in these subjects and in age- and sex-matched controls were normal and not significantly different. No individuals had a fused parietomastoid suture with open squamosal and/or sphenoparietal sutures.CONCLUSIONSFusion and partial fusion of the sphenoparietal, squamosal, and parietomastoid sutures is common in children and adolescents. It usually does not represent craniosynostosis and does not require cranial surgery. The anterior squamosal suture is often the earliest length of these sutures to fuse. Fusion then spreads anteriorly to the sphenoparietal suture and posteriorly to the parietomastoid. The sphenoparietal suture is generally the earliest minor lateral suture to complete fusion, and the parietomastoid is the last. Atypical patterns of fusion include posterior (without anterior) squamosal suture fusion and asymmetrical squamosal and/or parietomastoid suture fusion. However, these atypical fusion patterns may not lead to atypical head shapes or a need for surgery.
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Wilkinson, C. Corbett, Nicholas V. Stence, Cesar A. Serrano, Sarah J. Graber, Lígia Batista-Silverman, Emily Schmidt-Beuchat, and Brooke M. French. "Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions." Journal of Neurosurgery: Pediatrics 25, no. 5 (May 2020): 519–28. http://dx.doi.org/10.3171/2019.11.peds1953.
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OBJECTIVERecently, the authors investigated the normal course of fusion of minor lateral calvarial sutures on “3D” volume-rendered head CT reconstructions in pediatric trauma patients. While evaluating these reconstructions, they found many more fused sagittal sutures than expected given the currently accepted prevalence of sagittal craniosynostosis. In the present study, using the same set of head CT reconstructions, they investigated the course of fusion of the sagittal as well as the lambdoid, coronal, and metopic sutures.METHODSThey reviewed all volume-rendered head CT reconstructions performed in the period from 2010 through mid-2012 at Children’s Hospital Colorado for trauma patients aged 0–21 years. Each sagittal, lambdoid, coronal, or metopic suture was graded as open, partially fused, or fused. The cephalic index (CI) was calculated for subjects with fused and partially fused sagittal sutures.RESULTSAfter exclusions, 331 scans were reviewed. Twenty-one subjects (6%) had fusion or partial fusion of the sagittal suture. Four of the 21 also had fusion of the medial lambdoid and/or coronal sutures. In the 17 subjects (5%) with sagittal suture fusion and no medial fusion of adjacent sutures, the mean CI was 77.6. None of the 21 subjects had been previously diagnosed with craniosynostosis. Other than in the 21 subjects already mentioned, no other sagittal or lambdoid sutures were fused at all. Nor were other coronal sutures fused medially. Coronal sutures were commonly fused inferiorly early during the 2nd decade of life, and fusion progressed superiorly and medially as subjects became older; none were completely fused by 18 years of age. Fusion of the metopic suture was first seen at 3 months of life; fusion was often not complete until after 2 years.CONCLUSIONSThe sagittal and lambdoid sutures do not usually begin to fuse before 18 years of age. However, more sagittal sutures are fused before age 18 than expected given the currently accepted prevalence of craniosynostosis. This finding is of unknown significance, but likely many of them do not need surgery. The coronal suture often begins to fuse inferiorly early in the 2nd decade of life but does not usually complete fusion before 18 years of age. The metopic suture often starts to fuse by 3 months of age, but it may not completely fuse until after 2 years of age.
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Burrows, Annie M., Mark P. Mooney, Timothy D. Smith, H. Wolfgang Losken, and Michael I. Siegel. "Growth of the Cranial Vault in Rabbits with Congenital Coronal Suture Synostosis." Cleft Palate-Craniofacial Journal 32, no. 3 (May 1995): 235–46. http://dx.doi.org/10.1597/1545-1569_1995_032_0235_gotcvi_2.3.co_2.
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Craniofacial growth data from craniosynostotic children have shown that suture immobilization results in predictable restrictions of cranial vault growth in a direction perpendicular to the affected suture and compensatory growth at sutures perpendicular to the affected one. This study tests these predictions by using rabbits with nonsyndromic congenital coronal suture synostosis. Data were collected from 96 rabbits divided into three groups: 42 unaffected litter mate controls, 33 partially synostosed rabbits, and 21 completely synostosed rabbits. Markers were placed bilaterally on either side of the vault sutures at 1.5 weeks of age. Serial radiographs were taken at 1.5, 6, 12, and 18 weeks of age for assessment of growth at the vault sutures and of various cranial landmarks. Results revealed that completely synostosed animals had significantly (p <.05) shorter cranial vaults, reduced growth at the coronal suture, and increased growth at the sagittal, frontal, and squamosal sutures compared with unaffected rabbits. Results also showed that the calvarial growth observed in this craniosynostotic rabbit model closely reflects predicted compensatory patterns seen in human clinical populations and that this rabbit model is valuable for understanding the pathogeneses and craniofacial growth patterns of humans with premature cranial suture synostosis.
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Mooney, Mark P., Annie M. Burrows, Timothy D. Smith, H. Wolfgang Losken, Lynne A. Opperman, Jason Dechant, Amy M. Kreithen, et al. "Correction of Coronal Suture Synostosis Using Suture and Dura Mater Allografts in Rabbits with Familial Craniosynostosis." Cleft Palate-Craniofacial Journal 38, no. 3 (May 2001): 206–25. http://dx.doi.org/10.1597/1545-1569_2001_038_0206_cocssu_2.0.co_2.
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Objective: Resynostosis following surgical correction of craniosynostosis is a common clinical correlate. Recent studies suggest that the dura mater is necessary to maintain suture patency. It has also been hypothesized that dura mater from synostotic individuals may provide aberrant biochemical signals to the osteogenic fronts of the calvaria, which result in premature suture fusion and subsequent resynostosis following surgery. This study was designed to test this hypothesis by surgically manipulating the coronal suture and dura mater in rabbits with familial craniosynostosis to prevent postsurgical resynostosis. Design: Craniofacial growth and histomorphometric data were collected from 129 rabbits: 72 normal controls and 57 rabbits with bilateral coronal suture synostosis (15 unoperated on controls; 13 surgical controls; 9 dura mater transplant only; 10 suture transplant only; and 10 suture and dura mater transplant). At 10 days of age, all rabbits had radiopaque amalgam markers placed on either side of the coronal, frontonasal, and anterior lambdoidal sutures. At 25 days of age, 42 synostosed rabbits had a 3 to 5-mm wide coronal suturectomy. Coronal sutures and/or underlying dura mater allografts were harvested from same-aged, wild-type, isohistogenic control rabbits and transplanted onto the dura mater of synostosed host rabbits. Serial radiographs were taken at 10, 25, 42, and 84 days of age, and the suturectomy sites were harvested at 84 days of age in 44 rabbits and serially sectioned for histomorphometric examination. Results: Results revealed that cranial vault growth was significantly (p < .05) improved following surgical release of the fused coronal suture compared with synostosed rabbits who were not operated on but was still significantly different (p < .05) from that of normal control rabbits. By 84 days of age, significant (p < .05) differences were noted in calvarial suture marker separation, cranial vault shape indices, and cranial base angles between rabbits with and without dura mater allografts, probably as a result of resynostosis of the suturectomy site or suture-only allografts. Qualitative histological examination revealed that at 84 days of age rabbits with suture and dura allografts had patent coronal sutures, suture-only allografts had fused coronal sutures with extensive endosteal hyperostosis, dura mater–only allografts had some new bone in the suturectomy site that resembled rudimentary osteogenic fronts, and suturectomy controls had extensive endosteal bone formation and resynostosis of the suturectomy site. Significantly (p < .05) more bone was found in the suturectomy sites of rabbits without dura mater allografts compared with rabbits with dura mater allografts. Conclusions: Results support the initial hypothesis that normal dura mater allografts will maintain suture or suturectomy site patency and allow unrestricted craniofacial growth. However, it is still unclear whether the dura mater from normal rabbits was providing biochemical signals to the transplanted sutures or suturectomy sites or simply acting as a barrier to prevent abnormal biochemical signals from the dura mater of synostosed rabbits from reaching the calvaria. The clinical and therapeutic implications of these procedures are discussed.
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Bradley, James P., Jamie P. Levine, Christopher Blewett, Thomas Krummel, Joseph G. Mccarthy, and Michael T. Longaker. "Studies in Cranial Suture Biology: In Vitro Cranial Suture Fusion." Cleft Palate-Craniofacial Journal 33, no. 2 (March 1996): 150–56. http://dx.doi.org/10.1597/1545-1569_1996_033_0150_sicsbv_2.3.co_2.
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The biology underlying craniosynostosis remains unknown. Previous studies have shown that the underlying dura mater, not the suture itself, signals a suture to fuse. The purpose of this study was to develop an in vitro model for cranial-suture fusion that would still allow for suture-dura interaction, but without the influence of tensional forces transmitted from the cranial base. This was accomplished by demonstrating that the posterior frontal mouse cranial suture, known to be the only cranial suture that fuses in vivo, fuses when plated with its dura in an organ-culture system. In such an organ-culture system, the sutures are free from both the influence of dural forces transmitted from the cranial base and from hormonal influences only available in a perfused system. For the cranial-suture fusion in vitro model study, the sagittal sutures (controls that remain patent in vivo) and posterior frontal sutures (that fuse in vivo) with the underlying dura were excised from 24-day-old euthanized mice, cut into 5 × 4 × 2-mm specimens, and cultured in a chemically defined, serum-free media. One hundred sutures were harvested at the day of sacrifice, then every 2 days thereafter until 30 days in culture, stained with H & E, and analyzed. A subsequent cranial-suture without dura in vitro study was performed in a similar fashion to the first study, but only the calvariae with the posterior frontal or sagittal sutures (without the underlying dura) were cultured. Results from the cranial-suture fusion in vitro model study showed that all sagittal sutures placed in organ culture with the underlying dura remained patent. More importantly, the posterior frontal sutures with the underlying dura, which were plated-down as patent at 24 days of age, demonstrated fusion after various growth periods in organ culture. In vitro posterior frontal mouse-suture fusion occurred in an anterior-to-posterior direction but in a delayed fashion, 4 to 7 days later than in vivo posterior frontal mouse-suture fusion. In contrast, the subsequent cranial-suture without dura in vitro study showed patency of all sutures, including the posterior frontal suture. These data from in vitro experiments indicate that: (1) mouse calvariae, sutures, and the underlying dura survive and grow in organ-culture systems for 30 days; (2) the local dura, free from external influences transmitted from the cranial base and hormones from distant sites, influences the cells of its overlying suture to cause fusion; and (3) without dura influence, all in vitro cranial sutures remained patent. By first identifying the factors involved in dural-suture signaling and then regulating these factors and their receptors, the biologic basis of suture fusion and craniosynostosis may be unraveled and used in the future to manipulate pathologic (premature) suture fusion.
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Mooney, Mark P., Jocelyn M. Shand, Anne Burrows, Timothy D. Smith, John F. Caccamese, Gregory M. Cooper, James J. Cray, et al. "Rescue of Premature Coronal Suture Fusion with TGF-β2 Neutralizing Antibody in Rabbits with Delayed-Onset Synostosis." Cleft Palate-Craniofacial Journal 55, no. 6 (February 26, 2018): 844–55. http://dx.doi.org/10.1597/16-065.
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Objectives: An overexpression of Tgf-β2 leads to calvarial hyperostosis and suture fusion in individuals with craniosynostosis. Inhibition of Tgf-β2 may help rescue fusing sutures and restore normal growth. The present study was designed to test this hypothesis. Design: Twenty-eight New Zealand White rabbits with delayed-onset coronal synostosis had radiopaque markers placed on either side of the coronal sutures at 10 days of age. The rabbits were randomly assigned to: (1) sham control rabbits (n = 10), (2) rabbits with control IgG (100 μg/suture) delivered in a collagen vehicle (n = 9), and (3) rabbits with Tgf-β2 neutralizing antibody (100 μg/suture) delivered in a collagen vehicle (n = 9). Longitudinal growth data were collected at 10, 25, 42, and 84 days of age. Sutures were harvested at 84 days of age for histomorphometry. Results: Radiographic analysis showed significantly greater ( P < .05) coronal suture marker separation, craniofacial length, cranial vault length, height, shape indices, cranial base length, and more lordotic cranial base angles in rabbits treated with anti-Tgf-β2 antibody than in controls at 42 and 84 days of age. Histologically, rabbits treated with anti-Tgf-β2 antibody at 84 days of age had patent and significantly ( P < .05) wider coronal sutures and greater sutural area compared to controls. Conclusions: These data support our hypothesis that antagonism of Tgf-β2 may rescue fusing coronal sutures and facilitate craniofacial growth in this rabbit model. These findings also suggest that cytokine therapy may have clinical significance in infants with progressive postgestational craniosynostosis.
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Wu, Yii-Der, Chi-Hui Chien, Yuh J. Chao, Jack C. Yu, and Mathew A. Williamson. "Fourier Analysis of Human Sagittal Sutures." Cleft Palate-Craniofacial Journal 44, no. 5 (September 2007): 482–93. http://dx.doi.org/10.1597/06-122.1.
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Objective: To evaluate the complexity of human sagittal suture patterns and to investigate whether the suture complexity correlates with age. Design: Geometric patterns of the sagittal sutures from 104 dry human skulls from the Terry Collection and 16 computed tomography images from the Bosma Collection, aged 2 months to 60 years, were digitized. The complexity of the patterns was presented by suture length, curved suture (or skull) length, and length ratio and the frequency and amplitude contents by the discrete Fourier transform (DFT) analysis. Results: The suture length along the skull showed a positive correlation with age from 2 months to 10 years, reflecting the growth of the skull. The suture length ratio, R, a measure of the complexity of the suture pattern, had a similar trend to suture length (i.e., increased with age to about 10 years and leveled off afterward, accompanied by a large scatter). The major frequency from the DFT analysis indicated an age-related development in suture complexity from infants to about 10 years and no further change for individuals older than 10 years. Conclusions: Quantitative analyses of human sagittal suture using length, length ratio, and DFT indicated that there is a progressive increase in the complexity of sagittal sutural waveform with age, especially in the early ages. These findings agree with the observations from animal experiments that sagittal sutural waveform is the result of intrinsic tissue response to extrinsic forces such as those generated by the temporalis.
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Lipatov, Vyacheslav A., Dmitriy A. Severinov, Artem A. Denisov, Sergey V. Lazarenko, and Nikolay N. Grigor’yev. "Research of physical and mechanical characteristics of suture material in experiment in operations on liver." I.P. Pavlov Russian Medical Biological Herald 28, no. 2 (July 3, 2020): 193–99. http://dx.doi.org/10.23888/pavlovj2020282193-199.
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Taking into account the peculiarities of the blood supply to the liver and the structure of its parenchyma, and, as a result, considerable difficulties in providing reliable hemostasis without additional traumatization, a surgeon needs to be careful when performing a surgical manipulation. Despite a large number of modern methods for stopping parenchymal bleeding, many practi-tioners give preference to classic methods of hemostasis, including ligation of bleeding vessels in the bulk of the organ using specialized sutures. One of the most serious complications of the use of suture material is cutting of organ tissue, which leads to enhanced bleeding and expansion of the area of damage. At the moment, the tactics of choosing suture material for surgical procedures is empirical. In this context, the aim of this study was to assess the physico-mechanical properties of suture material regarding its structure, and to develop a criterion for choosing surgical sutures for surgical procedures. For the study, the liver was removed out of corpses of males of 35 to 40 years of age, after which separate sections of 7.574 cm in size were obtained from it. Then a wound 3 cm long and 2 cm deep was made. The wound was sutured with a simple interrupted suture without tightening, but with application of one simple half-node. For suturing, catgut, twisted capron and polyglycolide thread were used. Attention was paid to the maximal force applied at the moment of cutting (Fmax) and the degree of pulling the thread at the moment of cutting (Lu). The analysis of the data was based on comparison of Fmax and Lu parameters. This method permits to refuse from the empirical approach to the choice of suture material for operations on the liver, and to develop a criterion for choosing surgical sutures.
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Regelsberger, Jan, Tobias Schmidt, Björn Busse, Julia Herzen, Michael Tsokos, Michael Amling, and Felix Beckmann. "Synchrotron–microcomputed tomography studies of normal and pathological cranial sutures: further insight." Journal of Neurosurgery: Pediatrics 5, no. 3 (March 2010): 238–42. http://dx.doi.org/10.3171/2009.10.peds09138.
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Object Both CT and high-frequency ultrasound have been shown to be reliable diagnostic tools used to differentiate normal cranial sutures from suture synostosis. In nonsynostotic plagiocephaly, overlapping of the bony plates and the so-called “sticky suture” is still controversial and is believed to represent a pathological fusion process. Synchrotron–microcomputed tomography (SRmCT) studies were undertaken to determine whether positional head deformities can be assumed to be true suture pathologies. Methods Morphological features and growth development of 6 normal cranial sutures between the ages of 3 and 12 months were analyzed histologically. Additionally 6 pathological sutures, including sagittal synostosis and nonsynostotic plagiocephaly (NSP), were compared with the group of normal sutures by histological and SRmCT studies. Synchrotron-microcomputed tomography is a special synchrotron radiation source with a high photon flux providing a monochromatic x-ray beam with a very high spatial resolution. Morphological characteristics of the different suture types were evaluated and bone density alongside the sutures was measured to compare the osseous structure of the adjacent bony plates of normal and pathological sutures. Results Histologically jointlike osseous edges of the normal sutures were seen in the 1st month of life and interlocking at the age of approximately 12 months. During this 1st year, bone thickness increases and suture width decreases. The SRmCT studies showed that: 1) sutures and adjacent bones in NSP are comparable to normal sutures in terms of their morphological aspects; 2) bone densities in the adjacent bony plates of NSP and normal sutures are not different; 3) thickening of the diploe with ridging of the bone in sagittal synostosis is associated with significantly higher bone density; 4) synostotic sutures are only partially fused but vary in their extent; and 5) nonfused sections in sagittal synostosis behave like normal sutures without any signs of pathological bone formation. Conclusions Sutures in patients with NSP were found without any morphological irregularities or different osseous structures alongside those compared with normal sutures. Thus, a true suture pathology or osseous change of the adjacent bony plates is highly unlikely in NSP. Even though the number of specimens is limited in this series, cranial suture fusion seems to start at one undetermined point and spread along the suture, whereas other parts of the same suture are not involved according to morphological aspects and bone density measurements of the adjacent bones. This theory may represent a dynamic fusion process completed over time but just starting too early.
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Woller, Jessica L., Ki Beom Kim, Rolf G. Behrents, and Peter H. Buschang. "An assessment of the maxilla after rapid maxillary expansion using cone beam computed tomography in growing children." Dental Press Journal of Orthodontics 19, no. 1 (January 2014): 26–35. http://dx.doi.org/10.1590/2176-9451.19.1.026-035.oar.
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INTRODUCTION: With the advent of cone beam computed tomography (CBCT), it is now possible to quantitatively evaluate the effects of rapid maxillary expansion (RME) on the entire maxillary complex in growing patients. OBJECTIVE: The purpose of this study is to use three-dimensional images to evaluate the displacement that occurs at the circummaxillary sutures (frontonasal, zygomaticomaxillary, intermaxillary, midpalatal, and transpalatal sutures) following rapid maxillary expansion in growing children. METHODS: The CBCT scans of 25 consecutively treated RME patients (10 male, 15 female) with mean age of 12.3 ± 2.6 years, were examined before expansion and immediately following the last activation of the expansion appliance. RESULTS: Statistically significant (P < 0.05) amounts of separation were found for the displacement of the bones of the frontonasal suture, the intermaxillary suture, the zygomaticomaxillary sutures, and the midpalatal suture. The change in angulation of the maxillary first molars due to RME was also statistically significant. There was no statistically significant displacement of the transpalatal suture. CONCLUSIONS: Rapid maxillary expansion results in significant displacement of the bones of circummaxillary sutures in growing children.
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Cyprus, Garrett N., Jefferson W. Overlin, Rafael A. Vega, Ann M. Ritter, and René Olivares-Navarrete. "Spatial regulation of gene expression in nonsyndromic sagittal craniosynostosis." Journal of Neurosurgery: Pediatrics 22, no. 6 (December 2018): 620–26. http://dx.doi.org/10.3171/2018.6.peds18229.
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OBJECTIVECranial suture patterning and development are highly regulated processes that are not entirely understood. While studies have investigated the differential gene expression for different sutures, little is known about gene expression changes during suture fusion. The aim of this study was to examine gene expression in patent, fusing, and fused regions along sagittal suture specimens in nonsyndromic craniosynostosis patients.METHODSSagittal sutures were collected from 7 patients (average age 4.5 months) who underwent minimally invasive craniotomies at the Children’s Hospital of Richmond at VCU under IRB approval. The sutures were analyzed using micro-CT to evaluate patency. The areas were classified as open, fusing, or fused and were harvested, and mRNA was isolated. Gene expression for bone-related proteins, osteogenic and angiogenic factors, transforming growth factor–β (TGF-β) superfamily, and Wnt signaling was analyzed using quantitative polymerase chain reaction and compared with normal sutures collected from fetal demise tissue (control).RESULTSMicro-CT demonstrated that there are variable areas of closure along the length of the sagittal suture. When comparing control samples to surgical samples, there was a significant difference in genes for Wnt signaling, TGF-β, angiogenic and osteogenic factors, bone remodeling, and nuclear rigidity in mRNA isolated from the fusing and fused areas of the sagittal suture compared with patent areas (p < 0.05).CONCLUSIONSIn nonsyndromic sagittal craniosynostosis, the affected suture has variable areas of being open, fusing, and fused. These specific areas have different mRNA expression. The results suggest that BMP-2, FGFR3, and several other signaling pathways play a significant role in the regulation of suture fusion as well as in the maintenance of patency in the normal suture.
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Audibert, Priscila, César Jaeger Drehmer, Daniel Danilewicz, and Larissa Rosa de Oliveira. "Do cranial suture age and growth layer groups correlate in South American pinnipeds?" Journal of the Marine Biological Association of the United Kingdom 98, no. 3 (January 23, 2017): 635–44. http://dx.doi.org/10.1017/s0025315416001739.
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Age is one of the most important life history parameters required to understand the dynamics of mammalian populations. Growth Layers Groups (GLGs) are incremental units of calcified tissue in the teeth (dentine and cementum), which represent a pattern of cyclical deposition that can be counted. However, the estimation of absolute age in GLGs demands a skull with teeth, the permission to destroy part of a tooth, equipment to cut the teeth, and experienced GLGs readers. In 1954 Sivertsen proposed an alternative method using cranial suture age (CSA) to establish age categories. However, there are no studies validating the CSA in relation to GLGs. Thus, this study examined whether there is a correlation between age categories proposed by the CSA and chronological age in years from GLGs of South American fur seals (Arctocephalus australis) (N = 52) and of South American sea lions (Otaria flavescens) (N = 37). 93% of the skulls of A. australis and 83.8% of O. flavescens corresponded accurately to the age in years estimated by each cranial suture age range. These results indicated the existence of high correspondence between the CSA and the GLGs age (r: 0.491 for A. australis and r: 0.675 for O. flavescens). However, an adaptation to Sivertsen's method is recommended: using only eight sutures (excluding the premaxillary-maxillary suture for CSA analysis, due to its late fusion), and updating the intervals for cranial sutures, that correspond to 16–32 = adults, 11–15 = young and 8–10 = pups.
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Rozen, Todd D. "Cranial suture headache: An extracranial head pain syndrome originating in the cranial sutures of the skull." Cephalalgia Reports 4 (January 1, 2021): 251581632110400. http://dx.doi.org/10.1177/25158163211040072.
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Objective: To define a new type of head pain syndrome termed “cranial suture headache” which is a localized headache originating along the cranial suture lines of the skull. Background: Well localized headaches maybe extracranial in origin. As trigeminal nociceptors are localized within the cranial sutures of the skull, these fibrous joints maybe the source of head pain for some patients. Methods: Case series. To diagnose cranial suture headache, the patient’s pain had to be localized to the skull and elicited/mimicked by mild to moderate palpation over one or more distinct cranial suture lines. Results: Ten cases are presented. Most of the patients were women (9/10). The headache started daily from onset in all cases. Range of age of headache onset was 32–64 years. Headache was one sided, unless confined to the midline and typically lacked any migrainous and/or cranial autonomic symptoms. Most cranial suture headaches localized to either the sagittal, coronal or squamosal suture lines. Headache duration prior to diagnosis was on average 8.5 years. Triggering events: three began immediately after head trauma, two had very remote head trauma, one was post infectious, one was post craniotomy, while three patients had no known triggering event. All patients were treatment refractory failing at least three preventive medications. All improved with localized anesthetic injection to the suture line(s) and/or onabotulinum toxin A injection only to the cranial sutures. Discussion: Without the recognition of cranial suture-based pain, patients may have unremitting headaches that can last years to decades. The observation that “cranial suture” headache improves with localized treatment only to the cranial sutures would seem to suggest the extracranial origin of the pain.
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Siddiqui, Maria, Syeda Sahar Zahra, Syeda Taskeen Ejaz, Bazgha Sahar, Nabila Eajaz, and Saima Raees Ahmad. "Comparison of Wound Infection with Absorbable Suture Versus Non-Absorbable Suture after Cesarean Section." Pakistan Journal of Medical and Health Sciences 16, no. 11 (November 30, 2022): 264–66. http://dx.doi.org/10.53350/pjmhs20221611264.
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Objective: To compare the frequency of wound infection with absorbable suture and non-absorbable suture after cesarean section. Study Design: A randomized controlled trial. Place and Duration: Department of Obstetrics and Gynaecology, Nisthar Hospital, Multan from August 2021 to June 2022. Methodology: A total of 826 women (413 in each group) undergoing cesarean section were included. In Group-A absorbable suture was employed while in Group-B, non-absorbable suture was used. Post-operatively, all patients were followed up weekly and the final assessment of wound infection was done after 15 days. Results: In a total of 826 cases, mean age was 26.47±3.42 years. Mean body mass index was 25.62±1.87 kg/m2 and obesity was present in 166 (20.1%). Of these 826 study cases, emergency cesarean section was performed in 593 (71.8%). Mean duration of procedure was 38.43±12.21 minutes and 562 (68.0%) had duration of procedure below 40 minutes. Overall, wound infection was noted in 145 (17.6%) women, In Group-A, wound infection was noted in 96 (23.2%) women and in Group-B it was in 49 (11.9%) (p<0.0001). Practical Implications: Clinicians can employ non-absorbable sutures to decrease the risk of post-operative wound infection after cesarean section. Conclusion: We found non-absorbable sutures after cesarean section to yield significantly less rates of wound infection when compared to absorbable sutures. Keywords: Absorbable suture, Non-absorbable suture, wound infection, cesarean section.
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Eakin, Colin L., Paul Dvirnak, Chris M. Miller, and Richard J. Hawkins. "The Relationship of the Axillary Nerve to Arthroscopically Placed Capsulolabral Sutures." American Journal of Sports Medicine 26, no. 4 (July 1998): 505–9. http://dx.doi.org/10.1177/03635465980260040501.
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Ten cadaveric shoulders (mean donor age, 60.5 years) underwent arthroscopic placement of capsulolabral sutures as performed during arthroscopic reconstruction for shoulder instability. In relation to the glenoid face, the sutures were placed anterior, anteroinferior, inferior, posteroinferior, and posterior. All sutures entered the capsule approximately 1 cm away from the glenoid and exited beneath the labrum, and were tied using arthroscopic knot-tying techniques. The shoulders were frozen in the lateral arthroscopic position of approximately 45° of abduction and 20° of flexion and sectioned in the plane of the glenohumeral joint. The axillary nerve was then dissected, and the average distance from the nerve to each suture was found to be 16.7 mm at the anterior position, 12.5 mm at the anteroinferior position, 14.4 mm at the inferior position, 24.1 mm at the posteroinferior position, and 32.3 mm at the posterior position. In no specimen was any suture closer to the axillary nerve than 7 mm. We noted a statistically significant trend for the nerve to lie closest to the anteroinferior suture and gradually recede from the remaining sutures lying more posteriorly. This anatomic study is the first to demonstrate a relatively safe margin for arthroscopic suture placement between the capsule and axillary nerve when these sutures are placed approximately 1 cm from the glenoid rim.
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Wasay, Hafiz Ali, Muhammad Aamir Jameel, Muhammad Imran Anwar, HaroonJavaid Majid, and Sameen Tahir. "Comparative effects of suture and non-suture surgical techniques on platysma after Thyroid surgery." Pakistan Journal of Medical and Health Sciences 15, no. 7 (July 26, 2021): 1661–64. http://dx.doi.org/10.53350/pjmhs211571661.
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Background: Thyroidectomy is a routine general surgical procedure and pain after thyroidectomy is responsible for prolongation of hospital stay and increased risk of respiratory complications. Platysma is routinely sutured at the end of thyroidectomy before wound closure. This randomized controlled trial was conducted to compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Aim: To compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Place and duration of study: Dept. of Surgery at Sh. Zayed Hospital, Lahore from 26-12-2019 to 25-06-2020. Methodology: It is a randomized controlled trial study which consists of 92 patients, between 18 to 70 years of age in both gender and planned for thyroidectomy for nodular thyroid enlargement. Patients were randomly allocated into two treatment groups. After excision of thyroid, platysma was sutured as per conventional practice in one group while in the other group platysma was not sutured. For pain assessment Visual Analogue Scale (VAS) was used to 24 hours after surgery. Results: The mean age was 36.4±13.4 years. The mean VAS score for post-operative pain measured 24 hours after the surgery was significantly lower in patients undergoing thyroidectomy without platysmal suture as compared to those with conventional suturing of platysma during thyroidectomy (2.37±0.97 vs. 3.67±1.28; p <0.001). Similar significant difference was also noted between groups and subgroups which based on patient’s age, gender, BMI and educational status. Conclusion: Avoiding the suturing of platysma significantly reduced the post-operative pain which advocates a change in current practice and encourages non-suturing of platysma to decrease the morbidity of patients in post-operative period. Keywords: Thyroidectomy, Platysma, Suture, No Suture, Pain
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Ali Buzdar, Zulfiqar, Maryam Shahid, Kanwal Zahra, Muhammad Anwar Sibtain Fazli, Javaid Munir, Zia ul Haq, and Fakhar uz Zaman. "Study of Sexual Dimorphism in the Closure of Sagittal Suture – A Postmortem Study." Pakistan Journal of Medical and Health Sciences 15, no. 9 (September 30, 2021): 2319–22. http://dx.doi.org/10.53350/pjmhs211592319.
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Background: Performing identity is a prime task in medicolegal and postmortem examinations. Age is the first parameter that has to be determined followed by sex. There are several techniques through which sex can be determined. As well there are different anatomical, physiological and pathological parameters determination of sex. Aim: To determine the sexual dimorphism in the cranial sagittal suture closure macroscopically. Methods: All the cases for this purpose had been selected from those brought for autopsy in the Department of Forensic Medicine and Toxicology, King Edward Medical University Lahore during the year 2016. Results: The statistical analysis revealed early closure in males than in females both ectocranially and endocranially with advancing age in the sagittal suture of cranial vault. The p value was found significant being less than 0.05 thereby establishing the fact that sexual dimorphism in the cranial sagittal suture exists. Conclusion: Conclusively the determination of sex is possible from the pattern of Cranial Sutures closure on autopsy table. Key words: Sex, Sagittal, Suture, Cranial
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Ishchenko, A. I., A. V. Murashko, A. I. Davydov, M. G. Sonich, Yu N. Tarasenko, A. A. Ishchenko, O. V. Gorbenko, N. S. Trifonova, and N. I. Borisova. "New double-sided self-locking suture technique for cesarean section." Voprosy ginekologii, akušerstva i perinatologii 20, no. 1 (2021): 162–67. http://dx.doi.org/10.20953/1726-1678-2021-1-162-167.
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Objective. To improve the technique for cesarean section and reduce the incidence of postoperative complications using selflocking surgical (anchor) sutures. Design and results. The study involved 86 patients who underwent cesarean delivery at the age from 18 to 40 years, similar in demographic parameters, somatic status, parity, pregnancy complications and the number of cesarean sections in history. Two groups of patients were allocated: the first (main) group – 46 women, in whom a double-sided single-row suture with a selflocking suture anchor without reverse tip was used to repair a wound on the uterus (patent RU2729747C1); the second (comparison group) – 40 women; a double-row suture to repair the uterine wound involving multifilament sutures was used. For a number of characteristics (the duration of operation, the duration of suturing of the uterus, the restoration of physical activity during the first day, the need for analgesics, the activity of reparative processes in the myometrium), the advantage of a singlerow suture anchor was noted. Conclusion. The developed method provides conditions for the activation of reparative processes in the myometrium and potentiates rapid rehabilitation of patients after surgery. However, further research is needed to introduce the method into widespread clinical practice. Key words: cesarean section, incompetent uterine scar, isthmocele, double-sided single-row suture, self-locking suture anchor
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Poisson, Elyane, James J. Sciote, Richard Koepsel, Gregory M. Cooper, Lynne A. Opperman, and Mark P. Mooney. "Transforming Growth Factor-β Isoform Expression in the Perisutural Tissues of Craniosynostotic Rabbits." Cleft Palate-Craniofacial Journal 41, no. 4 (July 2004): 392–402. http://dx.doi.org/10.1597/02-140.1.
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Objective To describe the expression patterns of the various transforming growth factor-β (Tgf-β) isoforms, known to be involved in suture development, in the perisutural tissues of rabbits with naturally occurring craniosynostosis and relate such differential expression to the pathogenesis of premature suture fusion. Method Twenty-one coronal sutures were harvested from six wild-type control New Zealand White rabbits and five rabbits with familial coronal suture synostosis at 25 days of age for histomorphometric and immunohistochemical analyses. Tgf-β isoform immunoreactivity was assessed using indirect immunoperoxidase procedures with specific antibodies. Results Synostosed sutures had significantly (p < .01) greater bone area and relatively more osteoblasts and osteocytes in the osteogenic fronts, compared with wild-type sutures. Tgf-β isoform immunoreactivity showed differential staining patterns between wild-type and synostosed perisutural tissues. In wild-type sutures, Tgf-β1 and Tgf-β3 immunoreactivity was significantly (p < .001) greater than Tgf-β2 staining in all perisutural tissues. In synostosed sutures, the opposite pattern was observed, with Tgf-β2 immunoreactivity significantly (p < .001) greater than Tgf-β1 and Tgf-β3 in the osteogenic fronts, dura mater, and periosteum. Conclusions Findings from this study suggest that an overexpression of Tgf-β2, either in isolation or in association with an underexpression of Tgf-β1 and Tgf-β3, may be related to premature suture fusion (craniosynostosis) in this pathological rabbit model. These abnormal expression patterns may be involved in premature suture fusion either through increased cell proliferation, decreased apoptosis of the osteoblasts or both at the osteogenic fronts.
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Mooney, Mark P., Timothy D. Smith, Annie M. Burrows, Herbert L. Langdon, Cynthia E. Stone, H. Wolfgang, Losken, Kelly Caruso, and Michael I. Siegel. "Coronal Suture Pathology and Synostotic Progression in Rabbits with Congenital Craniosynostosis." Cleft Palate-Craniofacial Journal 33, no. 5 (September 1996): 369–78. http://dx.doi.org/10.1597/1545-1569_1996_033_0369_cspasp_2.3.co_2.
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The purpose of the present study was to describe coronal suture pathology and cross sectional synostotic progression in an inbred strain of rabbits with congenital craniosynostosis. Calvaria from 102 perinatal rabbits (39 unaffected; 63 bilateral or unilateral synostosis) were collected at fetal days 21 (n = 12), 25 (n = 20), 27 (n = 22), 30 (term) (n = 32), and 3 days post-term (n = 16) for gross morphologic and histologic examination. Synostotic foci, the extent of relative bony bridging, and suture morphology were evaluated qualitatively and quantitatively. Of the 204 coronal sutures examined, 91 sutures were synostosed, and 113 were patent. All synostosed sutures showed similar foci by day 25, which originated as bony bridges in the middle of each suture on the ectocortic surface. Bony bridging width increased significantly (p < .001) from day 25 through 3 days post-term, and was best described by a linear regression equation. Osteogenic front areas of synostosed sutures were up to 2.5 times greater than patent sutures in term fetuses. Findings demonstrate that coronal suture synostosis in the congenital rabbit model (1) begins early during suture morphogenesis (before 25 days of gestation); (2) consistently radiates from a single focus corresponding to a normal interdigitating region (i.e., a high-tension environment); (3) varies in onset and rate as evidenced by low R2 value between age and extent of bony bridging; and (4) is the result of early hyperostosis of the osteogenic fronts and sutural agenesis. A number of possible pathogenetic mechanisms are discussed.
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Brand, Jessica, Achim Langenbucher, Elena Zemova, Tanja Stachon, Melanie Weber, Jerome Rebmann, Berthold Seitz, and Nóra Szentmáry. "Impact of Pre- and Intraoperative Factors on Endothelial Cell Density in the Early and Late Stage after Penetrating Keratoplasty." Klinische Monatsblätter für Augenheilkunde 238, no. 08 (May 17, 2021): 904–11. http://dx.doi.org/10.1055/a-1333-2723.
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Abstract Aim This retrospective investigated the impact of donor age, recipient age, donor endothelial cell density, vis-à-tergo, and additional intraoperative lens exchange (triple-procedure) on overall early and late phase postoperative endothelial cell density (ECD) following penetrating keratoplasty (PKP) in various diagnosis groups. Patients and Methods In 590 cases with diagnosed keratoconus (KC), Fuchs dystrophy (FD) and herpes simplex virus infection (HSV) who underwent PKP or triple surgery, the ECD in cells/mm2 was analysed, both preoperatively, with all-sutures-in (early postoperative stage), and after last suture removal. The factors were tested by Mann-Whitney U-test, correlation analysis and linear regression analysis. Outcome Correlation analysis demonstrated a weak negative correlation between the patientʼs ECD and donor age (early postoperative stage: r = − 0.25, p < 0.001; after last suture removal: r = − 0.16; p = 0.003). Regression analysis revealed that donor age did not impact postoperative patient ECD. There was a weak negative correlation between postoperative ECD and recipient age (early postoperative stage: r = − 0.31, p < 0.001; after last suture removal: r = − 0.34, p < 0.001). Regression analysis confirmed the negative impact of recipient age on patient ECD (early postoperative stage: β = − 13.2, p = 0.001; after last suture removal: β = − 4.6, p < 0.001). Correlation analysis determined a weak positive correlation between postoperative ECD and donor endothelial cell density (early postoperative stage: r = 0.37, p < 0.001; after last suture removal: r = 0.32, p < 0.001). Regression analysis also determined that donor endothelial cell density had a positive impact on postoperative ECD following last suture removal (β = 0.4, p < 0.001). Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD (p > 0.05). This was also confirmed by the results of the regression analysis after last suture removal. Conclusion Recipient age and donor endothelial cell density have a significant impact on postoperative ECD following PKP. Not all of the statistical tests proved donor age to be a significant influencing factor. Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD following PKP.
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Macdonald, Peter, Nadia Primiani, and Adam Lund. "Are patients willing to remove, and capable of removing, their own nonabsorbable sutures?" CJEM 14, no. 04 (July 2012): 221–27. http://dx.doi.org/10.2310/8000.2012.120451.
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ABSTRACTObjectives:Providing patients with instructions and equipment regarding self-removal of nonabsorbable sutures could represent a new efficiency in emergency department (ED) practice. The primary outcome was to compare the proportion of patients successfully removing their own sutures when provided with suture removal instructions and equipment versus the standard advice and follow-up care. Secondary outcomes included complication rates, number of physician visits, and patient comfort level.Methods:This prospective, controlled, single-blinded, pseudorandomized trial enrolled consecutive ED patients who met the eligibility criteria (age > 19 years, simple lacerations, nonabsorbable sutures, immunocompetent). The study group was provided with wound care instructions, a suture removal kit, and instructions regarding suture self-removal. The control group received wound care instructions alone. Outcomes were assessed by telephone contact at least 14 days after suturing using a standardized questionnaire.Results:Overall, 183 patients were enrolled (93 in the intervention group; 90 in the control group). Significantly more patients performed suture self-removal in the intervention group (91.5%; 95% CI 85.4–97.5) compared to the control group (62.8%; 95% CI 52.1–73.6) (p< 0.001). Patients visited their physician less often in the intervention group (9.8%; 95% CI 3.3–16.2) compared to the control group (34.6%; 95% CI 24.1–45.2%) (p< 0.001). Complication rates were similar in both groups.Conclusion:Most patients are willing to remove, and capable of removing, their own sutures. Providing appropriate suture removal instructions and equipment to patients with simple lacerations in the ED appears to be both safe and acceptable.
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Vastardis, H., J. B. Mulliken, and J. Glowacki. "Unilateral Coronal Synostosis: A Histomorphometric Study." Cleft Palate-Craniofacial Journal 41, no. 4 (July 2004): 439–46. http://dx.doi.org/10.1597/03-012.1.
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Objective This histomorphometric study compared the open and prematurely fused side of the coronal suture in subjects with unilateral coronal synostosis (UCS). Methods Sutures and parasutural bone were obtained from seven subjects with nonsyndromic UCS during operative correction at 3 to 24 months of age. Histological and cellular analyses were performed for the affected and open sutures. Specimens were examined by light and polarizing microscopy. Sutural patterns, osseous morphology, calvarial thickness, tartrate-resistant acid phosphatase (TRAP)-positive cells, and marrow spaces were evaluated histomorphologically, qualitatively, and semiquantitatively. Histomorphometry was performed to determine total projected area of marrow space as a percentage of unit area, total number of TRAP-positive cells per specimen, and perisutural cranial thickness. Results Polarizing microscopy showed that affected sutures were composed of more lamellar bone than the normal sutures. By light microscopy, the clinically fused sutures were 1.7-fold thicker (p < .02), had twofold larger marrow spaces (p < .0006), and contained sixfold more TRAP-positive osteoclasts in marrow spaces near the suture (p < .04) than the normal sutures. Quantitative analysis of the normal sutures revealed that calvarial thickness was greater with age and that there was an inverse correlation between medullary area and age. For the affected sutures, there was also an age-related increase in calvarial thickness. There were also trends for age-related declines in numbers of osteoclasts in both open and affected sides. Conclusions These results question the hypothesis that defective osteoclastic activity is pivotal in the pathogenesis of UCS and support the hypothesis that this condition results from abnormally active bony remodeling.
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Laas, Enora, Cécile Poilroux, Corinne Bézu, Charles Coutant, Serge Uzan, Roman Rouzier, and Elisabeth Chéreau. "Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study." International Journal of Breast Cancer 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/819578.
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Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-)coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC) in breast surgery with and without the use of TC-coated sutures.Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1) and 98 with TC-coated sutures (Group 2). We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach.Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95) (). There was a significant difference in Group 2 between predicted probabilities and observed percentages (). The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively.Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.
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Belk, John W., Jonathan T. Bravman, Rachel M. Frank, Adam J. Seidl, and Eric C. McCarty. "Pectoralis Major Tendon Repair: Transosseous Suture Technique." Video Journal of Sports Medicine 2, no. 6 (November 2022): 263502542211310. http://dx.doi.org/10.1177/26350254221131058.
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Background: Pectoralis major ruptures are rare injuries that occur in young men between 20 and 40 years of age, typically during resistance training in the eccentric phase of muscle contraction. As the incidence of these ruptures increases with increasing activity levels and use of anabolic steroids, it is important to understand effective repair techniques. Indications: Repair of the ruptured pectoralis major tendon is indicated for young, active patients seeking to regain full functionality of the affected upper extremity. Technique Description: In short, after the pectoralis major is identified, the insertion site is revealed just lateral to the biceps tendon. The site for the bone trough is then exposed through cauterization of superficial tissue, and a cortical bone trough is drilled vertically using a small round burr. The location of 3 pilot holes is identified just lateral to the cortical bone trough, and then the holes are drilled to allow for placement of the anchors later in the procedure. The tendon itself is then identified, and sutures are placed in the bulk of the muscle tendon in a Krackow fashion. After the tendon is properly sutured, it is placed under tension to test the structural integrity of the suture pattern and ensure proper load capacity. The sutures are then passed through the pilot holes, the tendon is pulled down into the trough, and the sutures are tied down to the bone. Results: After an appropriate rehabilitation protocol is followed for up to 6 months postoperatively, the transosseous suture technique in the context of pectoralis major tendon repairs allows for adequate tissue to bone healing and near-complete restoration of patient functionality and strength. Conclusion: Acute repair of pectoralis major tendon tears using a transosseous suture technique is effective in restoring upper extremity strength and functionality and is associated with high patient satisfaction. 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.
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Abdilkarim, Dana Abdulmagid. "The The Effectiveness of Posturicular Fascial Flap as an Adjunct to Suture Otoplasty." Kurdistan Journal of Applied Research 1, no. 1 (March 1, 2016): 41–58. http://dx.doi.org/10.24017/10.24017/science.2016.1.1.4.
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Mustardé technique of otoplasty is probably the most famous and practical among all otoplasty procedures especially in our centers. Yet it possesses the risk of suture extrusion, stitch granulomas and recurrence. Such complications have been reported, albeit few, yet they are bothersome to patients and their families. Placing tissues between the suture lines and the postauricular incision whether grafts or fascial flaps have been reported to reduce these complications.This study was set to evaluate the effectiveness of elevating a post-auricular fascial flap to cover the sutures in Mustardé and Furnas techniques for reducing the risk of suture extrusion and granulomas and possibly recurrence.Eleven patients with prominent ears (21 ears) fit our inclusion criteria. Nine of them were males and two females. They underwent suture otoplasty with post-auricular fascial flap in Burn and Plastic Surgery Hospital in Sulaimania from December 2011 to July 2015. Their mean age was 15.5 years, with a mean follow-up period of 242 days (ranged from 66 days to 431 days. Polydioxanone suture was used in (6 ears), and polypropylene suture was used in (15 ears).We achieved 91% satisfaction rates among patients and their families (only one patient was unsatisfied). One patient developed partial recurrence of the middle half of antihelix in one side (4.7%). Another one developed bleeding that only needed pressure and change dressing in the left ear (4.7%). Adding fascial flap to cover the sutures appears to be beneficial in preventing suture extrusions and granulomas and possibly recurrence by acting as another supporting layer.
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Katti, Girish, Syed Shahbaz, Chandrika Katti, and Mohd Sabyasachi Rahman. "Evaluation of Midpalatal Suture Ossification Using Cone-Beam Computed Tomography: A Digital Radiographic Study." Acta Medica (Hradec Kralove, Czech Republic) 63, no. 4 (2020): 188–93. http://dx.doi.org/10.14712/18059694.2020.62.
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Background: Cone beam computed tomography (CBCT) imaging techniques are the recent rage in the field of oral diagnostic imaging modality. It is noninvasive, faster and lacks anatomic superimposition. Earlier maxillary occlusal radiographs were used to assess and evaluate the mid palatal suture, but being a two dimensional imaging modality it could not assess the ossification process which takes place in multiple planes mostly due to curved nature of the palate. In this study we assessed the mid palatal suture morphology and classify them according to the variants using CBCT images. Materials and methods: A total of 200 CBCT scans (95 males and 105 females) were evaluated in the present study from the archives of an imaging center. As per Angelieri classification the midpalatal suture was classified into five categories (A–E) depending on the degree of ossification that had taken place. Statistical analysis was done by Chi Square test using SPSS version 23.0. Results: There is statistically significant difference present in the stages of maturity of mid palatal suture in various age groups with Stage B is most common in Group 1 (50%), Stage C most common in Group 2 (60%) and Group 3 (40%) and Stage E more common in Group 4 (50%). Conclusion: The results of the present study showed a wide variation in the initiation time and the degree of ossification and morphology of the midpalatal suture in different age groups. Although there was an increase in the closure of the suture with aging, age is not a reliable criterion for determining the open or closed nature of the suture. This finding is important in providing an idea as to how diverse is the ossification of maxillary sutures.
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Tedman, R. "Sex- and age-related variations in cranial measurements and suture closure in the Australian sea lion, Neophoca cinerea (Peron, 1816)." Australian Journal of Zoology 51, no. 5 (2003): 463. http://dx.doi.org/10.1071/zo02077.
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A total of 65 skulls of the Australian sealion, Neophoca cinerea, was examined to investigate the extent to which sexual dimorphism is reflected in cranial dimensions (n = 32) and skull growth, and to determine whether cranial sutures (n = 18) can be useful in age determination. All adult skull dimensions studied display significant sexual dimorphism. Skull growth ceases close to 4–7 years of age for females (Suture Fusion Rating, SFR 25–34) but skull growth in males continues until at least 16 years of age. In animals with a SFR ≥� 25, male skulls have a minimum condylobasal length of 272 mm, whereas female skulls have a maximum condylobasal length of 259 mm. The relatively early closure of the cranial vault sutures (cessation of brain growth) is balanced by the continued growth of the bony projections that provide muscle attachment (e.g. mastoid width). The later fusion of the snout and palate sutures corresponds with the continued growth of the snout and palate to match the prolonged growth of the mandibles. The upper sixth postcanine tooth was present in 43% of the adult female skulls, but only 15% of the adult male skulls. The data suggest that it may be possible to determine age(s) from examination of the sequence of fusion of cranial sutures as well as by calculation of an overall suture fusion rating for the skull.
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Khan, Umar Jamal, Nosheela Javed, Khurram Arif, and Muhammad Amjad Chaudhary. "Skin Closure with Vicryl Vs Prolene in Day Case Surgeries." Pakistan Journal of Medical and Health Sciences 16, no. 5 (May 30, 2022): 1540–42. http://dx.doi.org/10.53350/pjmhs221651540.
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Objective: To compare the post-operative outcomes after skin closure with Vicryl as compared to Prolene in paediatric day case surgeries. Study Design: Comparative Cross-sectional Study Place and Duration of Study: Department of Paediatric Surgery, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad for six months (1st November,2021 to 30th April,2022) Patients and Methods: A total of sixty patients under the age of 12 years, who presented for day-case surgeries were divided into two groups: Vicryl (group A) and Prolene (group B). A single surgical team performed all the surgeries. The incidence of outcomes, such as pain, hematoma, infection, suture breakage and keloid formation was recorded after the procedure. At the 30th post-operative day, the scar assessment scale was used to evaluate the wound's healing. Results: Comparitive Cross-sectional study was conducted on 60 patients who underwent surgeries, having 30 in each group. Age and scar score for both the groups were compared. There was no sigfnificant difference observed for age p = 0.628 and it was significant for scars p = 0.007. Incidence of pain and infection was not statistically significant p ≥ 0.05. No hematoma, keloids and suture breakage were observed in both the sutures. Success Rate of Vicryl was 76.7% and that of Prolene was 93.3%. Success was positively correlated with scar r = 0.685. Conclusion: In our paediatric samples, we analyzed and concluded that prolene suture was better as compared to vicryl in terms of pain and infection. Keywords: Absorbable sutures, Day-case surgeries, Non-absorbable sutures, Prolene, Vicryl.
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Jeon, Ji Yoon, Sung-Hwan Choi, Chooryung Judi Chung, and Kee-Joon Lee. "The success and effectiveness of miniscrew-assisted rapid palatal expansion are age- and sex-dependent." Clinical Oral Investigations 26, no. 3 (November 25, 2021): 2993–3003. http://dx.doi.org/10.1007/s00784-021-04281-0.
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Abstract Objectives This study aimed to assess the success rate and the amount of suture separation after the miniscrew-assisted rapid palatal expansion (MARPE) procedure in relation to the chronological age and sex of the patients. Materials and methods The periapical radiographs of 215 subjects (95 male; 120 female; range, 6–60 years) who had undergone MARPE treatment were retrospectively analyzed. The success of suture separation was determined and, in suture-separated subjects, the amount of suture separation was evaluated by suture separation ratio calculated from the periapical radiograph obtained after active expansion. Association tests were performed using linear-by-linear association, the Jonckheere-Terpstra test, Fisher’s exact test, and the Mann–Whitney U test, and linear regression models were also developed. Results The success rate of suture separation was 61.05% in male, 94.17% in female, and 79.53% in both sexes. There was a statistically significant association between older age and suture nonseparation in male (p < 0.001), but not in female (p = 0.221). In suture-separated subjects, there was a statistically significant trend toward a low amount of suture separation with older age subgroups in both sexes (p < 0.001); however, there was no statistically significant difference in the amount of suture separation between male and female in all age subgroups. Conclusions Older patients treated with MARPE, particularly in male, may have a reduced likelihood of both success in suture separation and sufficient basal bone expansion. Clinical relevance This study demonstrates that clinicians should consider that the success rate of MARPE and the amount of suture separation may depend on chronological age and sex.
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Kothari, Reena, Prachir Mukati, and Dhananjaya Sharma. "ACDC: a simple app for abdominal wall closure data collection." International Journal of Research in Medical Sciences 6, no. 7 (June 25, 2018): 2512. http://dx.doi.org/10.18203/2320-6012.ijrms20182846.
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Background: With the aims of getting evidence-based guidelines and decision making, well supported by strong, high quality data. We have developed an easy surgeon friendly mobile app which can be customized to the need by just decoding it.Methods: We have use this app to analyze the outcomes of midline rectus sheath closure with different techniques and different sutures in terms of SSI, wound dehiscence, suture knot granuloma, burst abdomen and incisional hernia(IH). All the details regarding patient’s demographic status, surgical technique, suture used and follow up were recorded in the form of EDC (Electronic Data Collection) with the mobile app.Results: Total 595 cases with mean age 48 years underwent midline closure. The most preferred technique was continuous running technique with polypropylene suture (54.1%) followed by herringbone technique with polypropylene suture (27.7%), continuous running technique with polyglactin suture (18. 2%).The incidence of IH was 4.05% with continuous running technique with polypropylene suture. The data of desired variables can be accessed easily just by few clicks.Conclusions: This mobile app is reliable, fast, cost effective, and generates a credible and valid data along with the basic statistical analysis.
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Bittner, James G., Michael A. Edwards, Malay B. Shah, Bruce V. Macfadyen, and John D. Mellinger. "Mesh-Free Laparoscopic Spigelian Hernia Repair." American Surgeon 74, no. 8 (August 2008): 713–20. http://dx.doi.org/10.1177/000313480807400808.
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Varied Spigelian hernia mesh repair techniques have been described, although evidence suggests laparoscopy results in less morbidity and shorter hospitalization compared with open procedures. Laparoscopic suture repair of Spigelian hernias is rarely reported. Two patients with small Spigelian hernias (≤2 cm) were diagnosed and repaired laparoscopically using a transabdominal suture technique. Under laparoscopic guidance, a suture-passer was used to place two or three transfacial, interrupted 0 polypropylene sutures along the horizontal plane of the defect. Sutures were tied extracorporeally and closure was confirmed laparoscopically. These cases spurred a review of world literature (2001–2007) including clinical characteristics, operative techniques, and urgency of operations in Spigelian hernia patients. Data were compared using Fisher's exact test. One year postoperatively, the patients are without sequelae or recurrence. Literature review demonstrated most patients were females ( P < 0.001), ranged in age from 60 to 80 years ( P = 0.042), and presented with left-sided hernias ( P = 0.026). Open mesh repair (182/392 cases; 47%) was the most common technique; however, increasingly articles describe laparoscopic mesh repair. Mesh-free laparoscopic suture repair is feasible and safe. This novel uncomplicated approach to small Spigelian hernias combines the benefits of laparoscopic localization, reduction, and closure without the morbidity and cost associated with foreign material.
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Mooney, Mark P., H. Wolfgang Losken, Michael I. Siegel, Janice F. Lalikos, Albert Losken, Annie M. ,. Burrows, and Tim D. Smith. "Development of a Strain of Rabbits with Congenital Simple Nonsyndromic Coronal Suture Synostosis Part II: Somatic and Craniofacial Growth Patterns." Cleft Palate-Craniofacial Journal 31, no. 1 (January 1994): 8–16. http://dx.doi.org/10.1597/1545-1569_1994_031_0008_doasor_2.3.co_2.
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In the March 1993 issue of The Cleft Palate-Craniofacial Journal we reported a female rabbit born in our laboratory with complete bilateral coronal suture (CS) synostosis. This follow-up study presents our attempts to breed the animal and establish a strain of craniosynostotic rabbits. The second part of this study presents longitudinal somatic and craniofacial growth data in offspring with coronal suture synostosis. Serial growth data from 72 animals were collected for the present study. The sample consisted of 11 animals (10 offspring and the original female) with complete nonsyndromic unilateral (plagiocephalic) or bilateral (brachycephalic) CS synostosis, 19 animals with partial CS synostosis, and 42 unaffected control litter mates. At 10 days of age, all animals had radiopaque amalgam markers placed on either side of the frontonasal, coronal, anterior lambdoidal, and sagittal sutures. Body weights and serial lateral and dorsoventral head radiographs were taken at 1.5 (10 days), 6, 12, and 18 weeks of age. All animals showed similar body weights at 1.5 weeks of age, while completely synostosed animals exhibited a slight (about 12%), but significantly (p < .001) lowered body weight by 18 weeks of age. Results revealed that by 1.5 weeks of age the completely synostosed animals already exhibited brachycephalic cranial vaults, mid-facial hypoplasia, and increased flattening of the cranial base compared to unaffected siblings. This pattern continued through 18 weeks of age, with the partially synostosed animals exhibiting Intermediate morphologies. Compensatory overgrowths were noted primarily at the sagittal and frontonasal sutures, especially for completely synostosed animals. Findings revealed that the craniosynostotic rabbits followed predictable compensatory craniofacial growth patterns and exhibited secondary deformities similar to those reported for cases of human coronal suture synostosis. Such findings support continued efforts at developing this model to help understand, In part, the etiopathogenesis of this condition in human populations.
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Beuriat, Pierre-Aurélien, Alexandru Szathmari, Julie Chauvel-Picard, Arnaud Gleizal, Christian Paulus, Carmine Mottolese, and Federico Di Rocco. "Coronal and lambdoid suture evolution following total vault remodeling for scaphocephaly." Neurosurgical Focus 50, no. 4 (April 2021): E4. http://dx.doi.org/10.3171/2021.1.focus201004.
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OBJECTIVE Different types of surgical procedures are utilized to treat craniosynostosis. In most procedures, the fused suture is removed. There are only a few reports on the evolution of sutures after surgical correction of craniosynostosis. To date, no published study describes neosuture formation after total cranial vault remodeling. The objective of this study was to understand the evolution of the cranial bones in the area of coronal and lambdoid sutures that were removed for complete vault remodeling in patients with sagittal craniosynostosis. In particular, the investigation aimed to confirm the possibility of neosuture formation. METHODS CT images of the skulls of children who underwent operations for scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital, Lyon, France, from 2004 to 2014 were retrospectively reviewed. Inclusion criteria were diagnosis of isolated sagittal synostosis, age between 4 and 18 months at surgery, and availability of reliable postoperative CT images obtained at a minimum of 1 year after surgical correction. Twenty-six boys and 11 girls were included, with a mean age at surgery of 231.6 days (range 126–449 days). The mean interval between total vault reconstruction and CT scanning was 5.3 years (range 1.1–12.2 years). RESULTS Despite the removal of both the coronal and lambdoid sutures, neosutures were detected on the 3D reconstructions. All combinations of neosuture formation were seen: visible lambdoid and coronal neosutures (n = 20); visible lambdoid neosutures with frontoparietal bony fusion (n = 12); frontoparietal and parietooccipital bony fusion (n = 3); and visible coronal neosutures with parietooccipital bony fusion (n = 2). CONCLUSIONS This is the first study to report the postoperative skull response after the removal of normal patent sutures following total vault remodeling in patients with isolated sagittal synostosis. The reappearance of a neosuture is rather common, but its incidence depends on the type of suture. The outcome of the suture differs with the incidence of neosuture formation between these transverse sutures. This might imply genetic and functional differences among cranial sutures, which still have to be elucidated.
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Knaup, Britta, Faruk Yildizhan, and Heiner Wehrbein. "Age-Related Changes in the Midpalatal Suture." Journal of Orofacial Orthopedics / Fortschritte der Kieferorthop�die 65, no. 6 (November 2004): 467–74. http://dx.doi.org/10.1007/s00056-004-0415-y.
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Mohamad Noh, Nur Reza, Geng-Yi Yong, Siew-Ting Lee, Kui-Feng Low, and Shin-Wei Pan. "Patient satisfaction of pterygium surgery using fibrin glue versus suture autograft." Asian Journal of Ophthalmology 16, no. 3 (January 17, 2019): 186–92. http://dx.doi.org/10.35119/asjoo.v16i3.511.
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Purpose: To compare pterygium surgery with fibrin glue autografts and sutured autografts in terms of length of surgery time and postoperative patient satisfaction.
Methods: All pterygium operations performed at Sibu Hospital (Sarawak, Malaysia) between October 1, 2012 and September 30, 2013 were included.
Results: Eighty-one cases were included in the study. The fibrin glue group and suture group had 33 and 48 cases, respectively. The mean age of the patients was 50.56 (SD: 7.61). The fibrin glue group had a shorter mean duration of surgery (17.18 minutes, SD: 10.66) compared to the suture group (22.60 minutes, SD: 12.88) (P = 0.05). Patient satisfaction at first week review was 93.9% for the fibrin glue group and 75.0% for the suture group (P = 0.027, OR 5.2 [95%CI: 1.1, 24.9]). Patient satisfaction at sixth week review was 97.0% for the fibrin glue group and 77.1% for the suture group (P = 0.023, OR 9.5 [95%CI: 1.2, 77.8]). There was no serious adverse event in this study population.
Conclusion: Fibrin glue has shorter mean duration of surgery and significantly higher patient satisfaction at first week and sixth week post-pterygium surgery compared to the suture technique.
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Johnston, Stephen S., Brian Po-Han Chen, Giovanni A. Tommaselli, Simran Jain, and John B. Pracyk. "Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison." Journal of Wound Care 29, Sup5a (May 1, 2020): S9—S20. http://dx.doi.org/10.12968/jowc.2020.29.sup5a.s9.
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Objective: To compare economic and clinical outcomes of barbed sutures versus conventional sutures alone in wound closure for patients undergoing spinal surgery. Method: A retrospective study using the Premier Healthcare Database. The database was searched for patients who underwent elective inpatient spinal surgery (fusion or laminectomy) for a spinal disorder between 1 January 2014 and 30 June 2018 (first=index admission). Using billing records for medical supplies used during the index admission, patients were classified into mutually-exclusive groups: patients with any use of STRATAFIX (Ethicon, US) knotless tissue control devices (barbed sutures group); or patients with use of conventional sutures alone (conventional sutures group). Outcomes included the index admission's length of stay, total and subcategories of hospital costs, non-home discharge, operating room time (ORT, minutes), wound complications and readmissions within ≤90 days. Propensity score matching and generalised estimating equations were used to compare outcomes between the study groups. Results: After matching, 3705 patients were allocated to each group (mean age=61.5 years [standard deviation, SD±12.9]; 54% were females). Compared with the conventional suture group, the barbed suture group had significantly lower mean ORT (239±117 minutes, versus 263±79 minutes conventional sutures, p=0.015). Operating room costs were also siginificantly lower in the barbed suture group ($6673±$3976 versus $7100±$2700 conventional sutures, p=0.020). Differences were statistically insignificant for other outcomes (all p>0.05). Subanalysis of patients undergoing fusions of ≥2 vertebral joints yielded consistent results. Conclusion: In this study, wound closure incorporating barbed sutures was associated with lower ORT and operating room costs, with no significant difference in wound complications or readmissions, when compared with conventional sutures alone.
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Inoue, Kentaro, Taku Michiura, Junichi Fukui, Hiromi Mukaide, Takashi Ozaki, Hirokazu Miki, Masaki Kaibori, Sohei Satoi, Masanori Kon, and Madoka Hamada. "A Randomized Controlled Trial of Running Versus Interrupted Subcuticular Sutures for Skin Closure in Open Gastric Surgery." International Surgery 103, no. 5-6 (May 1, 2018): 305–14. http://dx.doi.org/10.9738/intsurg-d-16-00067.1.
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Objective: The aim of this study was to compare the scar quality associated with different types of subcuticular suture techniques: running or interrupted. Summary of Background Data: Subcuticular suture is a preferred skin closure method even in gastrointestinal surgery. Two methods for subcuticular suture are used: running or interrupted sutures. Methods: Inclusion criteria were as follows: age ≥ 20 years; American Society of Anesthesiologists performance status 1 to 3; histologically proven adenocarcinoma of the stomach; no evidence of distant metastases or disease considered unresectable; no prior upper abdominal surgery; no uncontrolled infections, diabetes, or cardiac disease; and adequate renal function. Patients were randomly assigned to running subcuticular suture or interrupted subcuticular suture. Scar areas were calculated using a digital photograph calculator at about 7 months after surgery. The observer scar assessment scale (OSAS) was used for scar assessment. Results: Between April 10, 2009, and February 28, 2012, 220 patients were enrolled into this study and 201 patients were evaluated. There was no difference in scar area between the interrupted group and the running group [0.97 cm2 (95% CI: 0.73–1.21) in the interrupted group and 1.17 cm2 (95% CI: 0.91–1.42, P = 0.27) in the running group]. Three observers performed the OSAS, for which no significant difference was detected across the closure groups. Conclusions: There were no significant differences in cosmetic outcomes between running and interrupted subcuticular sutures. The final decision about the choice of method should be made balancing surgeon needs (time-saving with running) and surgeon techniques (running might be difficult).
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Chotivatanapong, Taweesak, Pradistchai Chaiseri, Choosak Kasemsarn, and Vibhan Sungkahapong. "Chordal Replacement with Expanded Polytetrafluoroethylene Suture: Early Results." Asian Cardiovascular and Thoracic Annals 6, no. 1 (March 1998): 49–51. http://dx.doi.org/10.1177/021849239800600111.
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Expanded polytetrafluoroethylene suture has been used for chordal replacement to achieve better results of mitral valve repair in patients with severe subvalvular disease. From March 1994 to December 1996, 16 patients with mitral valve disease were successfully repaired with this suture at Central Chest Hospital. There were 10 males and 6 females. The average age was 36.5 years. Mean follow-up was 18.18 months. Mitral valve disease was rheumatic in origin in most patients. The suture was attached to the posterior leaflet in 11 patients and to the anterior leaflet in the other 5. The average number of pairs of sutures used per patient was 1.37 (range 1 to 4 pairs). The average number of surgical procedures for mitral valve repair per patient was 5.1. There was no hospital mortality and no thromboembolic complication or reoperation during this study. Postoperative functional status and mitral regurgitation improved substantially. We concluded from this study that this suture can be used safely and effectively for chordal replacement in mitral valve repair.
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Ali Shash, Hani, Sawsan Fahad Almarzouq, Abdulrahman Abdulaziz Alghamdi, and Hayam Ali Shash. "CASE REPORT: SQUAMOUS SUTURE SYNOSTOSIS IN RAINE SYNDROME CASE REPORT AND LITERATURE REVIEW." International Journal of Advanced Research 10, no. 12 (December 31, 2022): 1381–84. http://dx.doi.org/10.21474/ijar01/15980.
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The purpose of this case study review is to evaluate Squamous Suture synostosis in Raine syndrome. Raine syndrome is characterized by dysmorphic features including exophthalmos, microcephaly, gum hypertrophy, low-set ears, midface hypoplasia, and osteosclerosis. RS is closely associated with squamous suture synostosis, one of the lateral minor skull sutures separating the parietal and squamous temporal bones. The study examined a three-year-old Saudi male born to healthy parents and a known case of Raine syndrome, craniosynostosis, degenerative myopia, and cataract. The Computed tomography (CT) scan results showed that the patient had metopic craniosynostosis with squamosal suture craniosynostosis and high intracranial pressure (ICP). The findings show that the association between Squamous Suture synostosis and Raine syndrome is seen in osteoporosis-related to deficiency of carbonic anhydrase II. However, in Raine syndrome disorder, the calcifications are seen after one year of age in many cases. Thus, it can be noted that Raine syndrome is inherited as an autosomal recessive in FAM20C mutation and is most identified among children.
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Edgar, Cory M., Hardeep Singh, Elifho Obopilwe, Andreas Voss, Jessica Divenere, Michael Tassavor, Brendan Comer, George Sanchez, Augustus D. Mazzocca, and Matthew T. Provencher. "Pectoralis Major Repair: A Biomechanical Analysis of Modern Repair Configurations Versus Traditional Repair Configuration." American Journal of Sports Medicine 45, no. 12 (July 27, 2017): 2858–63. http://dx.doi.org/10.1177/0363546517716175.
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Background: Pectoralis major (PM) ruptures are increasingly common, and a variety of surgical techniques have been described. However, tested techniques have demonstrated diminished strength with inadequate restoration of the footprint and suture failure at relatively low loads. Purpose/Hypothesis: The purpose was to biomechanically compare PM transosseous suture repair (current gold standard) to modern PM repair techniques that use larger caliber sutures, suture tape, and unicortical button fixation (UBF). The null hypothesis was that there would be no mechanical difference between repair techniques and no difference in the amount of footprint restoration. Study Design: Controlled laboratory study. Methods: Twenty-four fresh-frozen cadaveric shoulders controlled for age and bone mineral density were randomized equally to 4 groups: (1) UBF, suture tape; (2) UBF, No. 5 suture, suture tape; (3) bone trough with No. 2 suture; and (4) native PM tendon group; all groups were tested to failure. The specimens were tested under cycling loads (10 N to 125 N) with a final load-to-failure test at 1 mm/s. Failure modes were classified by location and cause of rupture based on optical markers, while tendon footprint length was measured to determine amount of footprint restoration. Results: For fixation strength, the mean peak load was significantly greater in the native tendon (1816 ± 706 N) versus UBF/No. 5 suture/suture tape (794 ± 168 N), UBF/suture tape (502 ± 201 N), and bone trough (492 ± 151 N) ( P < .001 for all). UBF/No. 5 suture/suture tape featured the lowest displacement superiorly (1.09 ± 0.47 mm) and inferiorly (1.14 ± 0.39 mm) with a significant difference compared with bone trough. With regard to tendon footprint reapproximation, cortical button fixation best approximated native tendon footprint length versus bone trough. Conclusion: Based on peak failure load, the UBF/No. 5 suture/suture tape construct demonstrated 61% greater construct strength than a traditional bone trough technique. Moreover, displacement after cyclic loading was by far smallest in the UBF/No. 5 suture/suture tape construct. Therefore, repair constructs with larger caliber suture and suture tape provide a measurable improvement in construct strength versus traditional PM repair techniques in a biomechanical model and may be advantageous for repair. Clinical Relevance: Cortical button fixation with larger caliber suture and suture tape allows for a significantly better PM repair than more traditional techniques at the time of surgery, which may ultimately result in improved clinical outcomes if implemented in surgical practice.
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Saxena, Amol, Nicola Maffulli, Aidan Nguyen, and Albert Li. "Wound Complications from Surgeries Pertaining to the Achilles Tendon." Journal of the American Podiatric Medical Association 98, no. 2 (March 1, 2008): 95–101. http://dx.doi.org/10.7547/0980095.
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Background: A retrospective review of one surgeon’s practice was conducted to assess the prevalence of wound complications associated with acute and chronic rupture repair, peritenolysis, tenodesis, debridement, retrocalcaneal exostectomy/bursectomy, and management of calcific tendinopathy of the Achilles tendon. Methods: We evaluated the incidence of infection and other wound complications, such as suture reactions, scar revision, hematoma, incisional neuromas, and granuloma formation. Results: A total of 219 surgical cases were available for review (140 males and 70 females; mean ± SD age at the time of surgery, 46.5 ± 12.6 years; age range, 16–75 years). Seven patients experienced a wound infection, three had keloid formation, six had suture granulomas, and six had suture abscesses, for a total complication rate of 10.0%. Six patients had more than one complication; therefore, the percentage of patients with complications was 7.3%. There were no hematomas. Seven patients had additional surgery after their wound complications; some had simple granuloma excision, and one necessitated a flap. Patients with risk factors such as diabetes mellitus, smoking, and rheumatoid arthritis necessitating corticosteroid therapy were more likely to have a wound complication (Fisher exact test, P = .03). Conclusions: Complications with Achilles tendon surgery may be unavoidable. Suture granulomas may appear in a delayed manner. Absorbable and nonabsorbable sutures can be implicated. (J Am Podiatr Med Assoc 98(2): 95–101, 2008)
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Eppley, Barry L., James M. Platis, and A. Michael Sadove. "Experimental Effects of Bone Plating in Infancy on Craniomaxillofacial Skeletal Growth." Cleft Palate-Craniofacial Journal 30, no. 2 (March 1993): 164–69. http://dx.doi.org/10.1597/1545-1569_1993_030_0164_eeobpi_2.3.co_2.
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The potential effects of mini- and microfixation on craniofacial development was investigated in an animal model. Twenty-four rabbits had amalgam markers placed bilaterally at the lambdoid, coronal, and frontonasal sutures at 28 days of age. In group 1, plating was not done and served as controls. In groups 2 to 4, single 2- and 4-hole microplates and 4-hole miniplates were fixed across the left coronal suture. The right suture was not plated. After 6 months, intermarker distances and craniofacial angles were measured radiographically. Coronal sutures underneath the plates were also histologically evaluated. Plating across the coronal suture resulted in local anteroposterior constriction of marker distances that did not differ with the type of fixation used. More distant markers, however, were increased in all specimens as a compensation and, as a result, the cranionasal length of all groups were similar. No change in craniofacial angles was observed from that of the controls. Sutural morphology on the side of fixation was altered with decreased widths, cellular numbers, and bone deposition. These experimental results demonstrate that early plate application in a normal calvarium results in local growth restriction that can be overcome by regional bone growth compensation.
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Occhionorelli, Savino, Fabio Fabbian, Yuri Battaglia, Tommaso Miccoli, Dario Andreotti, Emanuele Di Simone, Sergio Gianesini, and Enzo Malvacini. "Evaluation of hemodynamic impact of absorbable sutures in native arteriovenous fistulas: A retrospective study." International Journal of Artificial Organs 43, no. 1 (September 26, 2019): 58–61. http://dx.doi.org/10.1177/0391398819877420.
Full textAbstract:
One of the major causes of arteriovenous fistula failure is the venous stenosis due to aggressive neointimal hyperplasia. The aim of the study was to assess the arteriovenous fistula maturation comparing absorbable sutures and non-absorbable ones in native vessels. Surgeries performed during a period of 24 months by a single team of expert surgeons were evaluated. Surgeries that met the inclusion criteria, namely, age ⩾ 18 years and radio-cephalic arteriovenous fistula, were considered. According to type of suture, patients were classified as Max group (absorbable suture) and Prol group (non-absorbable). Data pertaining to 70 patients were collected; 51% were men and the mean age was 73 ± 12 years. In Max group, an increasing blood flow was observed during the first 4 weeks without post-operative complications. In Prol group, six patients had thrombosis that resulted in vascular access failure. After the first week, the duplex Doppler ultrasound of both groups showed a regular arteriovenous fistula maturation, with an increase of blood flow rate. Although pre-operative post-tourniquet mean vein diameters of Max group were not adequate, the mean vein diameter and mean blood flow rate increased after 4 weeks, respectively. On the contrary, in Prol group, mean vein diameters and blood flow rate decreased. The maturation of arteriovenous fistula and its functional performance were not altered by the type of suture (absorbable/non-absorbable). Absorbable sutures were associated with good results considering arteriovenous fistula maturation.