Ex vivo biomechanical evaluation of polyester and polyblend suture techniques to perform equine laryngoplasty

Abstract

To validate the use of a polyblend tape suture in equine laryngoplasty (PL).Study design: Experimental study. Animals: Thirty-two cadaveric larynges.Methods: Each larynx was randomly assigned to 1 of 4 groups: PL with polyblend tape suture (TigerTape), without (TT) or with a cannula (TTC) in the muscular process of the arytenoid cartilage, and PL with polyester suture (Ethibond), without (EB) or with a cannula (EBC). Construct stiffness, total migration, creep, and drift values were measured after 3000 cycles. The specimens were then loaded to failure to assess their residual properties: load at failure, total energy, displacement, and 2 stiffness coefficients.Results: After cyclic testing, the total migration and creep were lower in TTC (6.36 ± 1.20 mm; 1.35 ± 0.38 mm/s) than in EB (11.12 ± 4.20 mm; 3.39 ± 2.68 mm/s) and in the TT constructs (11.26 ± 1.49 mm; 3.20 ± 0.54 mm/s); however, no difference was found with EBC (9.19 ± 3.18 mm; 2.14 ± 0.99). A correlation was found between total migration and creep (R = .85). The TTC constructs failed at higher loads (129.51 ± 33.84 N) than EB (93.16 ± 18.21 N) and EBC (81.72 ± 13.26 N) whereas the EB and EBC constructs were less stiff than TT and TTC (P < .001). Conclusion:Biomechanical properties were generally superior for the TTC constructs tested under cyclical loading. The TT and TTC constructs failed at a higher load than EB and EBC constructs. The cannula in TTC and EBC reduced the failure at the muscular process.Partial results of the study have been submitted and accepted as an oral communication at the 29th ECVS Congress, Valencia (Spain), 2-4 July 2020.

Variations in the application of equine prosthetic laryngoplasty: A survey of 128 equine surgeons

“…6,7,[17][18][19] Implications of needle selection for the muscular process were evident in the present study, with a more heterogeneous distribution of selection evident for the muscular process of the arytenoid cartilage compared to that reported for the cricoid cartilage. The published literature indicates multiple potential benefits from the use of an implant (for example a metallic screw or toggle) as part of the arytenoid-prosthesis construct; [6][7][8][9] however, it is evident that in the current study most surgeons still use a simple, single loop for placement of the prosthesis at the muscular process. The findings of the current study indicate that biomechanics is unlikely to be the only attribute considered by surgeons when selecting construct types in a clinical context.…”

“…Biomechanical research has also been important in relation to the selection of appropriate prosthesis materials. 9 , 13 , 14 , 15 The original description of the prosthetic laryngoplasty in 1970 utilized a polyurethane suture, 1 although a later survey in 1993 indicated that surgeons at that time elected to use a variety of other prosthesis materials. 4 Subsequent literature has continued to demonstrate the use of a large variety of different prosthesis materials in clinical practice.…”

“…Biomechanical attributes of the laryngoplasty construct have been a focus of recent research. Studies investigating specific components of the laryngoplasty have demonstrated benefits of variations, such as the use of a U‐shaped construct at the caudal border of the cricoid cartilage, 5 or the use of a metallic implant in the muscular process of the arytenoid cartilage construct 6–9 . However, how such variations influence factors other than biomechanics, and their application in clinical practice, are poorly documented.…”

“…Studies investigating specific components of the laryngoplasty have demonstrated benefits of variations, such as the use of a U‐shaped construct at the caudal border of the cricoid cartilage, 5 or the use of a metallic implant in the muscular process of the arytenoid cartilage construct. 6 , 7 , 8 , 9 However, how such variations influence factors other than biomechanics, and their application in clinical practice, are poorly documented. Other anecdotal considerations, such as the use of local antimicrobial therapy in clinical cases, have not been addressed in previous literature.…”