Initial Resistance of Carina Anastomoses with Increasing Tensile Stress: An ex vivo Model Comparing Different Suture Techniques

2016 ◽  
Vol 58 (1-2) ◽  
pp. 20-26 ◽  
Author(s):  
Andreas Kirschbaum ◽  
Stefanie Hemmerling ◽  
Thorsten Steinfeldt ◽  
Detlef K. Bartsch ◽  
Nikolas Mirow
Keyword(s):  
Tensile Stress ◽  
Ex Vivo ◽  
Main Bronchus ◽  
Suture Technique ◽  
Suture Techniques ◽  
Front Wall ◽  
Ex Vivo Model ◽  
Back Wall ◽  
Interrupted Suture ◽  
Intrabronchial Pressure

Background: After resection of the carina with a length of more than 4 cm, anastomoses often need to be performed under tension despite maximum mobilization. If the patient cannot be extubated, the anastomosis remains under continued stress. Anastomoses of the carina can be constructed using various suture techniques, including single interrupted sutures, back wall running but front wall single interrupted sutures, and complete running suture. This experimental study was designed to determine the most tensile stress-resistant anastomotic suture technique. Materials and Methods: Isolated preparations of tracheobronchial trees were recovered from freshly slaughtered pigs. Resection of the carina was carried out in preparation of the experiments. After blind randomization, anastomoses (n = 15 per group) between the distal trachea and the proximal left main bronchus were performed with PDS 4-0 employing three different suture techniques: (1) single interrupted sutures, (2) back wall running but front wall single interrupted sutures (= mixed technique), and (3) complete running suture. The anastomotic specimen was fixed onto a specially constructed device. The tracheal end was intubated with a tube (CH 8.0) and connected to a respirator. Different weights were attached to the distal end of the preparation via a clamp and guide rollers. Airtightness was investigated at the following tensile loads: 0, 500, 1,000 and 1,500 g. Intrabronchial pressure was increased in 5-mbar steps. In an underwater trial, we analyzed whether anastomoses were airtight at a maximum intrabronchial ventilation pressure of 70 mbar. Results: At an intrabronchial pressure of 25 mbar without tensile stress, all anastomoses were initially airtight. In tensionless anastomoses at 70 mbar, 100% of single interrupted and continuous sutures were airtight, as compared to 80% of sutures in mixed technique. At 70 mbar and tensile loads of 1,500 g, 80% of single interrupted sutures, 60% of sutures in mixed technique and 53% of the running sutures remained competent. Conclusion: If tracheal anastomoses can be performed without tension, the suture technique is not important. With increased tension, anastomoses performed in single interrupted suture technique were clearly superior. Thus, in situations, where high tensile stress is to be expected, single interrupted sutures should be preferred.

Initial Load Stability of Different Trachea Suture Techniques: Tests on an Ex Vivo Model

2018 ◽  
Vol 158 (6) ◽  
pp. 1079-1083 ◽  
Author(s):  
Andreas Kirschbaum ◽  
Helen Abing ◽  
Nikolas Mirow
Keyword(s):  
Tensile Stress ◽  
Ex Vivo ◽  
Tensile Load ◽  
Suture Technique ◽  
Suture Techniques ◽  
Maximum Pressure ◽  
Ex Vivo Model ◽  
Suture Group ◽  
Group 2 ◽  
Load Stability

Objective Tracheal anastomosis can be performed with different suture techniques. In this experimental work, the resilience of anastomotic techniques to pressure and tensile stress was studied. Study Design Ex vivo pig model. Setting Experimental. Subjects and Methods The trachea with the 2 main bronchi in freshly slaughtered pigs was isolated and intubated (CH 8.0). Both main bronchi were closed distally by a stapler. After resection of the trachea, an anastomosis (n = 15 per group) was created: group 1, single interrupted sutures; group 2, continuous running suture; group 3, mixed technique. A continuous tensile stress of 0, 500, 1000, or 1500 g was applied to the preparations. Mechanical ventilation with a maximum pressure of 70 mbar was initiated. The airtightness of the anastomosis was verified by submerging the entire preparation under water. Results At tensile loads of 0.5 and 1.0 kg, all anastomoses created in the single-stitch technique were airtight; at 1.5 kg, 93.3% were without leaks. In the continuous suture technique, the airtightness of anastomoses decreased with increasing tensile load: from 93.3% at 500 g to 73.3% at 1 kg and 66.6% at 1.5 kg ( P = .02 at 1.5 kg). Anastomoses in the mixed technique were airtight in 80% at 500 g, 66.6% at 1 kg, and 46.6% at 1.5 kg ( P = .01 in comparison with single stitches). Conclusion Anastomoses created with single interrupted sutures showed the highest resilience against combined pressure and tensile stress.

scholarly journals Comparison of clinical, biomechanical, and histopathological effects of various suture techniques on repair of tendon rupture by using autograft

2017 ◽  
Vol 61 (2) ◽  
pp. 231-237
Author(s):  
Celal Şahin Ermutlu ◽  
Vedat Baran
Keyword(s):  
Good Alternative ◽  
Suture Technique ◽  
Suture Techniques ◽  
Tissue Loss ◽  
Group Iii ◽  
Interrupted Suture ◽  
Group I ◽  
Tendon Ruptures ◽  
The Right ◽  
And Control

AbstractIntroduction: The purpose of this study was to compare the effectiveness of four different suture techniques in the treatment of experimentally modelled tendon injuries with tissue loss with autograft and grafting applications in rabbits.Material and Methods: The study was performed on 30 male mature (2-year-old) New Zealand rabbits with mean body weight of 3.1 kg, divided into three equal groups. A graft measuring 1 cm in length was collected from the m. tibialis cranialis of each rabbit under general anaesthesia. The graft collected from the right tendon was transplanted into the left tendon, and the graft from the left tendon was transplanted into the right tendon. In all groups, a simple interrupted suture was placed on the left tendon as control, a Bunnell-Mayer suture was placed on the right tendon in group I, a Locking-Loop suture in group II, and a Horizontal U suture in group III. Both hindlimbs were bandaged for four weeks. The tendons were assessed biomechanically and histopathologically.Results: According to the results of the tensile testing, the maximum durability of the techniques ranked as follows: Bunnell-Mayer, Horizontal U, Locking-Loop, and control groups.Conclusion: The use of autografts was a good alternative for the treatment of tendon ruptures with tissue loss. Furthermore, even though there were no clinical or histopathological differences, the suture technique can be chosen based on the results of the tensile test.

Investigation of the effects of two-, four-, six- and eight-strand suture repairs on the biomechanical properties of canine gastrocnemius tenorrhaphy constructs

2021 ◽  
pp. 1-7
Author(s):  
Yi-Jen Chang ◽  
Daniel J. Duffy ◽  
George E. Moore
Keyword(s):  
Failure Modes ◽  
Clinical Decision Making ◽  
Ex Vivo ◽  
Biomechanical Testing ◽  
Tendon Repair ◽  
Clinical Decision ◽  
Biomechanical Properties ◽  
Suture Technique ◽  
Gap Formation ◽  
Ex Vivo Model

Abstract OBJECTIVE To determine the effects of 2-, 4-, 6- and 8-strand suture repairs on the biomechanical properties of canine gastrocnemius tenorrhaphy constructs in an ex vivo model. SAMPLE 56 cadaveric gastrocnemius musculotendinous units from 28 adult large-breed dogs. PROCEDURES Tendons were randomly assigned to 4 repair groups (2-, 4-, 6- or 8-strand suture technique; n = 14/group). Following tenotomy, repairs were performed with the assigned number of strands of 2-0 polypropylene suture in a simple interrupted pattern. Biomechanical testing was performed. Yield, peak, and failure loads, the incidence of 1- and 3-mm gap formation, forces associated with gap formation, and failure modes were compared among groups. RESULTS Yield, peak, and failure forces differed significantly among groups, with significantly greater force required as the number of suture strands used for tendon repair increased. The force required to create a 1- or 3-mm gap between tendon ends also differed among groups and increased significantly with number of strands used. All constructs failed by mode of suture pull-through. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that increasing the number of suture strands crossing the repair site significantly increases the tensile strength of canine gastrocnemius tendon repair constructs and their resistance to gap formation. Future studies are needed to assess the effects of multistrand suture patterns on tendon glide function, blood supply, healing, and long-term clinical function in dogs to inform clinical decision-making.

scholarly journals Mechanical strength and hydrostatic testing of VIVO adhesive in sutureless microsurgical anastomoses: an ex vivo study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marius Heitzer ◽  
Julia Brockhaus ◽  
Kristian Kniha ◽  
Felix Merkord ◽  
Florian Peters ◽  
...  
Keyword(s):  
Animal Studies ◽  
Ex Vivo ◽  
Coronary Vessels ◽  
In Vitro Study ◽  
The Novel ◽  
Ex Vivo Model ◽  
Interrupted Suture ◽  
Tensile Forces

AbstractConventional anastomoses with interrupted sutures are challenging and inevitably associated with trauma to the vessel walls. The goal of this study was to evaluate a novel alternative adhesive-based suture-free anastomosis technique that uses an intraluminal stent. Overall, 120 porcine coronary vessels were analyzed in an ex vivo model and were examined for their mechanical (n = 20 per cohort) and hydrostatic strength (n = 20 per cohort). Anastomoses were made using the novel VIVO adhesive with an additional intraluminal nitinol stent and was compared to interrupted suture anastomosis and to native vessels. Sutureless anastomoses withstood pressures 299 ± 4.47 [mmHg] comparable to native vessels. They were performed significantly faster 553.8 ± 82.44 [sec] (p ≤ 0.001) and withstood significantly higher pressures (p ≤ 0.001) than sutured anastomoses. We demonstrate that the adhesive-based anastomosis can also resist unphysiologically high longitudinal tensile forces with a mean of 1.33 [N]. Within the limitations of an in vitro study adhesive-based suture-free anastomosis technique has the biomechanical potential to offer a seamless alternative to sutured anastomosis because of its stability, and faster handling. In vivo animal studies are needed to validate outcomes and confirm safety.

scholarly journals Posttraumatic disruption of the right main bronchus - a case report

2019 ◽  
Vol 72 (7-8) ◽  
pp. 248-250
Author(s):  
Bojan Koledin ◽  
Milos Koledin ◽  
Ivan Kuhajda ◽  
Sladjana Koledin
Keyword(s):  
Case Report ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Main Bronchus ◽  
Lung Parenchyma ◽  
Suture Technique ◽  
Sternal Fracture ◽  
Interrupted Suture ◽  
Right Thoracotomy ◽  
The Right

Introduction. Tracheobronchial disruption is a rare disorder, usually accompanied by a severe blunt chest trauma that quite rarely appears as an isolated event. Case Report. This is a case report of a right main bronchus disruption, due to an injury to the right hemithorax, caused by a falling tree trunk. The disruption was accompanied by mediastinal emphysema, fractures of the 4th and 5th ribs on the right side and compound sternal fracture. The patient was operated in general anesthesia, through right thoracotomy approach, followed by successful right main bronchus reconstruction by interrupted suture technique, without anatomic resection of the lung parenchyma. Conclusion. Although this injury is rare, with suspicion of bronchial rupture, bronchoscopy confirms the diagnosis and leads to better prognosis.

scholarly journals P048 A NEW MODALITY FOR BIOMECHANICAL VALIDATION OF CLOSURE TECHNIQUES OF LAPAROTOMIES

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Floris den Hartog ◽  
Dimitri Sneiders ◽  
John Vlot ◽  
Gert-Jan Kleinrensink ◽  
Johannes Jeekel ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Tissue Sample ◽  
Speckle Pattern ◽  
Tensile Load ◽  
Suture Technique ◽  
Fascial Closure ◽  
Ex Vivo Model ◽  
Tissue Samples ◽  
Pulling Forces ◽  
Set Up

Abstract Aim Incisional hernia remains one of the most frequent complications after abdominal surgery. Several closure techniques exist. However, fundamental biomechanical understanding of these techniques and of the differences in clinical outcomes are still lacking. It is thought that distribution of lateral forces on the midline plays a role. Testing in a clinical setting is limited by sample sizes, costs and ethical regulations. We propose a preclinical ex vivo model in which multiple closure configurations can be tested in a controlled setting, eliminating interfering variables existing in previously published, more complex abdominal wall models. Consequently, this allows a valid comparison between closure modalities based on biomechanical merits. Material and Methods The experimental set-up is represented by a vertical tensile load tester, in which a sutured tissue sample is clamped. The tissue samples are covered with a fine, random speckle pattern via miniscule ink droplets. A high-resolution camera captures the speckles as the tissue is subjected to linear pulling forces. Image analysis documenting relative movement of speckles as a means for measuring tissue deformation is performed in ex-vivo tissue samples, resulting in specific objective biomechanical characteristics for each closure configuration. Results Local tissue strain fields are visualized, and compared between closure modalities and correlated to known linear forces applied to the tissue. The latest results will be shared and discussed. Conclusions A new modality for biomechanical evaluation of closure techniques has been developed. Further validation and serial experiments with different closure modalities with and without mesh reinforcement can be performed in order to determine the biomechanically optimal suture-technique for fascial closure.

A standardized model for in vitro testing of sutures and patches for watertight dural closure

2021 ◽  
pp. 1-10
Author(s):  
Florian Ebel ◽  
Stefan Wanderer ◽  
C. Marvin Jesse ◽  
Ralph T. Schär ◽  
Irena Zubak ◽  
...  
Keyword(s):  
Double Layer ◽  
In Vitro Model ◽  
Infusion Pump ◽  
Suture Technique ◽  
Suture Techniques ◽  
Interrupted Suture ◽  
Dural Closure ◽  
Significant Difference ◽  
Vitro Model

OBJECTIVE CSF leaks are common complications of spinal and cranial surgeries. Several dural grafts and suture techniques are available to achieve watertight dural closure, but the effectiveness of these techniques remains unclear. The authors developed a standardized in vitro model to test available grafts and suture techniques alone or in combination to find the technique with the most watertight dural closure. METHODS A fluid chamber with a dural fixation device, infusion pump, pressure gauge, and porcine pericardium as a dural equivalent was assembled to provide the reusable device for testing. The authors performed dural closure in 4 different fashions, as follows: A) using running versus simple interrupted suture technique and different suture materials to close a 3-cm incision; B) selecting commonly used sealants and dural patches in combination with a running suture; C) performing duraplasty (1.5 × 1.5–cm square defect) with different dural substitutes in a stand-alone fashion; and D) performing duraplasty with different dural substitutes in a double-layer fashion. Each technique was tested 6 times. The hydrostatic burst pressure (BP) was measured and compared using the Kruskal-Wallis test or the Mann-Whitney U-test. Values are reported as mean ± SD. RESULTS There was no significant difference between the running and simple interrupted suture technique (p = 0.79). Adding a patch or sealant to a suture resulted in a 1.7- to 14-fold higher BP compared to solitary suture closure (36.2 ± 24.27 cm H2O and 4.58 ± 1.41 cm H2O, respectively; p < 0.001). The highest BP was achieved by adding DuraSeal or TachoSil (82.33 ± 12.72 cm H2O and 74.17 ± 12.64 cm H2O, respectively). For closing a square defect, using a double-layer duraplasty significantly increased BP by a factor of 4–12 compared to a single-layer duraplasty (31.71 ± 12.62 cm H2O vs 4.19 ± 0.88 cm H2O, respectively; p < 0.001). The highest BP was achieved with the combination of Lyomesh and TachoSil (43.67 ± 11.45 cm H2O). CONCLUSIONS A standardized in vitro model helps to objectify the watertightness of dural closure. It allows testing of sutures and dural grafts alone or in combination. In the authors’ testing, a running 6-0 monofilament polypropylene suture combined with DuraSeal or TachoSil was the technique achieving the highest BP. For the duraplasty of square defects, the double-layer technique showed the highest efficacy.

1849: Systematic Evaluation of 21μm Thulium Laser Device for Treatment of Benign Prostatic Enlargement in an Ex-VIVO Model

2007 ◽  
Vol 177 (4S) ◽  
pp. 614-614 ◽  
Author(s):  
Gunnar Wendt-Nordahl ◽  
Stefanie Huckele ◽  
Patrick Honeck ◽  
Peter Aiken ◽  
Thomas Knoll ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Systematic Evaluation ◽  
Thulium Laser ◽  
Laser Device ◽  
Benign Prostatic Enlargement ◽  
Ex Vivo Model ◽  
Prostatic Enlargement
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