Growth of tracheal anastomoses: Advantage of absorbable interrupted sutures

McKeown, Peter P.; Tsuboi, Hidetoshi; Togo, T; Thomas, Robert H.; Tuck, Richard; Gordon, David

doi:10.1016/0003-4975(91)90324-j

Cited by 25 publications

(19 citation statements)

References 11 publications

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“…A continuous suture provides an air and watertight seal [16,26]. However, recent studies have reported conflicting results with regard to the suitability of the continuous suturing technique for tracheal anastomosis [16,17]. In this study we investigated three frequently described suturing techniques: A continuous suture with a nonabsorbable monofilament material (polypropylene), a single interrupted suture with multifilament (polyglactin 910) and a monofilament (polydioxanone) suture.…”

Section: Discussionmentioning

confidence: 99%

Breaking Strength of Native and Sutured Trachea

Behrend¹,

Kluge²,

Schüttler³

et al. 2001

Eur Surg Res

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Tracheal anastomoses are, even more so than other sutures, often only possible to prepare under tension and thus in danger of breakage. No information is available regarding native tracheae and freshly sutured tracheae. For this reason, our objective was to examine the tensile strength of native tracheae and compare it with freshly sutured specimens. Fresh tracheae were collected from the local slaughterhouse within 30 min of slaughter. With the help of a suitable holding device, 24 fresh tracheae were mounted on a material testing machine and stretched to breaking point, during which the force and distance required were recorded. The same study was carried out on each 10 freshly anastomosed tracheae using three different suturing techniques. The mean value of the maximum force required for native tracheae was 198 N. With continuous suturing (polypropylene), a mean value of 171 N was attained, and with single interrupted suturing (polydioxanone and polyglactin 910), 123 N, respectively, 108 N. Differences between the groups proved to be highly significant. With respect to the mechanical strain from traction, the continuous suture proved to be statistically identical to native tracheae, whereas single interrupted sutures revealed a considerably lower stability under burden. Therefore, the continuous suture is of advantage in respect of the mechanical strain from traction and the suture protection of tracheal anastomoses. Further studies with differing survival times in vivo with this method provide insight into the stability of tracheal anastomoses during the healing process.

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Section: Discussionmentioning

confidence: 99%

Breaking Strength of Native and Sutured Trachea

Behrend¹,

Kluge²,

Schüttler³

et al. 2001

Eur Surg Res

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“…The tracheal epithelial healing was completed between postoperative days 7 and 14. It was characterized by loss of cilia and attenuation of the epithelial layer and metaplasia as described earlier [14,34,35].…”

Section: Discussionmentioning

confidence: 99%

“…Luminal stenosis at the anastomosis is the most significant discriminating factor when comparing techniques of tracheal anastomosis. The accuracy of techniques for calculating the percentage of a luminal stenosis varies considerably [14,20,31]. Planimetry, using a scanner, facilitated a precise and consistent measurement of the CSA.…”

Section: Discussionmentioning

confidence: 99%

“…These materials and techniques are not only a selection from existing literature, but also represent the personal preference and experience of outstanding experts [3,10,14,17,[30][31][32][33].…”

Section: Discussionmentioning

confidence: 99%

“…A continuous suture provides an air-and watertight seal [13,27]. However, recent studies have shown conflicting results with regard to the suitability of a continuous suture technique for tracheal anastomosis [13,14]. Some authors favour submucosally placed sutures which may be superior with respect to mucosal healing [10].…”

Section: Introductionmentioning

confidence: 99%

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Influence of Suture Material and Technique on End-to-End Reconstruction in Tracheal Surgery: An Experimental Study in Sheep

Behrend¹,

Klempnauer²

2001

Eur Surg Res

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Resection and end-to-end anastomosis of the trachea represent the preferred treatment for various benign and malignant diseases involving the trachea. Various studies have reported conflicting results with alternative techniques and suture materials for tracheal anastomosis. Our objective was to evaluate three frequently used techniques concerning stenosis rate and histological reaction in a large-animal species. Tracheal resection of 3 cm and end-to-end anastomosis were performed in 15 sheep with the use of three different techniques. In the first group, an interrupted suture with polyglactin, in the second group an interrupted suture with polydioxanone, and in the last group a continuous suture with polypropylene were used. The animals were killed 1, 2, 4, 8, and 24 weeks postoperatively. The luminal stenosis was determined by means of computerized planimetry. All three techniques appeared to be appropriate for tracheal anastomosis. The luminal stenosis developed within the first 8 weeks after surgery. A cross-sectional area of approximately 40–70% was finally achieved. Differences dependent on the suture material are less important than the technical details of the operation.

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