Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty

Abstract

Background Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for treatment of snoring and sleep apnea. In a prospective clinical trial, we compared a standard simple interrupted suture technique for closure of the tonsillar pillars with a running locked suture. Methods Each suture technique was randomly assigned either to the left or the right tonsillar pillars in 28 patients. During the first week, patients were daily checked for suture dehiscence and again on days 10 and 21, the end of followup. Time to perform the sutures was measured intraoperative and surgical complications were recorded. Results During followup, suture dehiscence was observed in 15/28 interrupted and 16/28 running sutures (p > 0.5). If a dehiscence occurred during the observation period, the median day of dehiscence was 10 (1 and 3 quartile: 5.75 and 17) days for the interrupted suture and 10 (5-11) days for the running locked suture technique (p > 0.05). The mean (± SD) surgical time for the interrupted suture was 5.2 ± 1.9 and 3.5 ± 1.8 min for the running locked suture (p < 0.001). Postoperative bleedings occurred in 4/28 running sutures and 2/28 interrupted sutures. Conclusion The running locked suture technique is an equally safe and time saving way of wound closure in UPPP and ESP.

Biomechanical properties of canine staphylectomies closed with barbed or smooth suture

“…56 Pulling the suture through the tissue to the transition zone allows opposing barbs to engage the tissue, reducing backward movement of the suture and eliminating the requirement to maintain axial tension on the suture to prevent loss of tissue apposition. 30,33,34 These properties are of great utility for palate surgery in the confined anatomic space of the oral cavity, which limits instrumentation and the ability to anchor suture, maintain tissue apposition, and tie knots with appropriate tension. [26][27][28][29][30][31] Propensity for knot slippage and difficulties in placing knots and achieving tissue approximation with smooth suture have been reported in man in areas of restricted access and instrumentation, such as the retromolar region and soft palate, and surgeons may tend to overcome these concerns by overtightening knots.…”

“…30,33,34 These properties are of great utility for palate surgery in the confined anatomic space of the oral cavity, which limits instrumentation and the ability to anchor suture, maintain tissue apposition, and tie knots with appropriate tension. [26][27][28][29][30][31] Propensity for knot slippage and difficulties in placing knots and achieving tissue approximation with smooth suture have been reported in man in areas of restricted access and instrumentation, such as the retromolar region and soft palate, and surgeons may tend to overcome these concerns by overtightening knots. 26,27,31 Tightly approximated wounds and overly tight sutures can lead to ischemia, inflammation, reduced wound strength, dehiscence, or excessive fibrosis, particularly undesirable outcomes in staphylectomy, a surgical site where wound complications can impact quality of life or prove life threatening.…”

“…26,27,31 Tightly approximated wounds and overly tight sutures can lead to ischemia, inflammation, reduced wound strength, dehiscence, or excessive fibrosis, particularly undesirable outcomes in staphylectomy, a surgical site where wound complications can impact quality of life or prove life threatening. [26][27][28][29][30][31][32][33][34][35][36][37][38]41,42 By contrast, engaged barbs provide uniform tension in the apposed tissues in a sustained manner during surgery and in the postoperative period, which may prevent incisional complications and dehiscence. 26,27,31 Surgical knots introduce stress concentrations into the strand and thin and stretch the material which greatly reduces suture tensile strength.…”

“…[22][23][24][25] Dehiscence of oral tissues is commonly reported in man after oral and nasopharyngeal surgery, and barbed suture systems have been used in these surgeries to more securely approximate tissues and limit dehiscence and associated complications. [26][27][28][29][30] Conventional suturing in a confined space with poor visualization such as the oral cavity may prolong anesthesia and cause surgeons to handle tissues with undue force, place excessive tension on sutures, approximate knots too tightly, or misappropriate sutures, leading to uneven tension distribution, ischemia, reduced wound strength, and possible dehiscence. 26,27,31 Barbed suture systems facilitate maintenance of tissue apposition and axial tension during suturing.…”

“…The use of barbed sutures has been shown to reduce operative times and tissue ischemia as well as improve tissue apposition, distribution of tension across the suture line, and wound healing. [26][27][28][29][30][31][32][33][34][35][36][37] Using barbed sutures in dogs, cats, and pigs for intraoral closure, tracheal resection and anastomosis, diaphragmatic herniorrhaphy, gastrotomy, gastropexy, enterotomy, cystotomy, tenorrhaphy, and closure of body wall and skin have yielded findings comparable with smooth suture with some distinct advantages, particularly higher forces to failure in biomechanical testing of incisional gastropexy and decreased duration of closure for all tissues studied. [38][39][40][41][42][43][44][45][46][47][48][49] The objective of this study was to compare the duration of closure and biomechanical properties of staphylectomies closed with absorbable bidirectional barbed suture or smooth monofilament suture in a simple continuous or interrupted pattern.…”