The influence of the type of material used, knot configuration, and use of an additional throw on the tensile force at failure, the elongation, and the mode of failure of different configurations of linear sutures and knotted suture loops was evaluated in this in-vitro mechanical study. We hypothesized that all types of knots would significantly influence the initial force and elongation of suture materials and would influence the force and elongation at which the knotted loops break, but not their mode of failure. A total of 432 samples of 4 types of size 3-0 suture material (polydioxanone, polyglecaprone 25, polyglactin 910, and nylon), representing 9 configurations, were tested in a tensiometer. The configurations were 1 linear suture without a knot and the following loops: square (SQ) knot; surgeon's (SU) knot; granny (GR) knot; and sliding half-hitch (SHH) knot using either 4 and 5 or 3 and 4 throws, depending on the material. For polydioxanone, SQ and SU knots did not decrease the initial force at failure of the suture. Granny (GR) and SHH knots decreased the tensile force at failure and elongation by premature failure of the loop. For polyglecaprone 25, all knots decreased the initial force at failure of the suture, with SHH being weaker than the other knots. For coated polyglactin 910, all knots decreased the initial force at failure of the suture and slippage increased significantly compared with the other 3 sutures. The use of SQ knots with 3 throws did not result in a safe knot. For nylon, knots did not alter the original mechanics of the suture. In conclusion, all knots and types of suture material do not necessarily have the same effect on the initial tensile force at failure of suture materials.

Objective- To compare the mechanical properties of laryngeal tie-forward (LTF) surrogate constructs prepared with steel fixtures and No. 5 braided polyester or braided polyethylene by use of a standard or a modified suture placement technique. Sample- 32 LTF surrogate constructs. Procedures- Surrogate constructs were prepared with steel fixtures and sutures (polyester or polyethylene) by use of a standard or modified suture placement technique. Constructs underwent single-load-to-failure testing. Maximal load at failure, elongation at failure, stiffness, and suture breakage sites were compared among constructs prepared with polyester sutures by means of the standard (n = 10) or modified (10) technique and those prepared with polyethylene sutures with the standard (6) or modified (6) technique. Results- Polyethylene suture constructs had higher stiffness, higher load at failure, and lower elongation at failure than did polyester suture constructs. Constructs prepared with the modified technique had higher load at failure than did those prepared with the standard technique for both suture materials. All sutures broke at the knot in constructs prepared with the standard technique. Sutures broke at a location away from the knot in 13 of 16 constructs prepared with the modified technique (3 such constructs with polyethylene sutures broke at the knot). Conclusions and Clinical Relevance- Results suggested LTF surrogate constructs prepared with polyethylene sutures or the modified technique were stronger than those prepared with polyester sutures or the standard technique.

Objective—To determine whether different suture configurations could improve the biomechanical performance of 3 suture materials used with bone anchors. Samples—3 suture materials (60-lb test nylon leader line, size 2 polyblend polyethylene composite suture, and 150-lb test ultrahigh–molecular weight spun polyethylene). Procedures—Each suture material was looped through the eyelet of a metallic bone anchor and constructs were evaluated by use of an acute uniaxial load. Three configurations were tested for each suture material: single stranded (SS), double stranded (DS), and single stranded plus plastic insert (SSP). Force at failure, extension at failure, force at 3 mm of extension, stiffness, and site of failure of the suture were recorded for each test. Results—For all sutures, the DS configuration was the stiffest and yielded significantly higher forces at failure and forces at 3 mm of extension. The SS configuration had the lowest forces at failure. The SSP configuration yielded greater forces at failure for all suture materials, compared with the SS configuration, with a comparable stiffness. All sutures failed at the eyelet in the SS and DS configurations. In the SSP configuration, 60-lb test nylon leader line and 150-lb test ultrahigh-molecular weight spun polyethylene failed at the eyelet less frequently than did the polyblend composite suture. Conclusions and Clinical Relevance—Among the tested constructs, a DS suture configuration used in combination with the metallic bone anchor gave the best biomechanical results for all suture materials. Considering that the SSP configuration yielded greater forces at failure, compared with the SS configuration, covering metallic edges in bone anchors with softer materials might protect sutures and result in increased forces at failure.

Two techniques for end-to-end anastomosis of the small colon were evaluated in each of 6 horses. A simple interrupted suture pattern that excluded the mucosa and was oversewn with an inverting suture was compared with a triangulated double-row pattern of stainless steel staples. Anastomotic sites were evaluated at 2 weeks, 2 months, and 6 months for extent of abdominal adhesions, lumen diameter at anastomotic sites, bursting pressures, and healing response. Clinical postoperative complications were not associated with either technique. At postmortem examination, there was extensive adhesion formation from the mesocolon to the stapled anastomotic site. The suture technique resulted in greater luminal diameters (P less than or equal to 0.05), with good apposition of the tissue layers. Staples were missing as early as 2 weeks after surgery, and their loss was associated with separation of the muscularis at later evaluation periods. Regardless of technique, all but one anastomotic segment burst away from the anastomotic site along the mesenteric taenial band. For the 12 anastomoses performed in normal horses, the suturing technique was better than the stapling technique because of significantly larger lumen diameters, better anastomotic healing, and minimal intra-abdominal adhesion formation.

OBJECTIVE To evaluate the effect of exposure to a balanced electrolyte solution (BES), or equine abdominal fat on the knot-holding capacity (KHC), relative knot security (RKS), weight, and volume of forwarder knots versus surgeon's knots. SAMPLE 315 knots tied and tested in vitro. PROCEDURES United States Pharmacopeia size-3 polyglactin 910 suture exposed to air (dry [control]), equine abdominal fat (fat-exposed), or BES (BES-exposed) was used to tie forwarder knots with 2, 3, and 4 throws and surgeon's knots with 5, 6, 7, and 8 throws. A universal materials testing machine was used to test the tensile strength of suture and knots to failure, and the KHC, RKS, weight, and volume of knots were determined. RESULTS Forwarder knots had significantly higher KHC and RKS and lower volume, compared with surgeons’ knots. Forwarder knots tied with fat-exposed suture had greater weight, but not volume, than did forwarder knots tied with dry or BES-exposed suture with the same number of throws. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that forwarder knots were superior to surgeon's knots when configured as start knots intended for continuous lines of suture. Exposure to media did not negatively affect mechanical or physical properties of forwarder knots and may improve specific biomechanical functions, including KHC and RKS.

Objective- To evaluate anatomic landmarks to define the ideal suture placement location to achieve appropriate and consistent arytenoid cartilage abduction via unilateral cricoarytenoid lateralization (UCL) in dogs. Sample- 6 cadaveric canine larynges. Procedures- Laryngeal airway resistance (LAR) was determined for each specimen before (baseline) and after suture placements with the epiglottis open and closed. To achieve UCL, suture was placed through the cricoid cartilage just caudal to the cricoarytenoid articulation (suture placement position [SPP] 1), one-fourth of the distance caudally between the cricoarytenoid and cricothyroid articulations (SPP 2), and three-fourths of the distance caudally between the cricoarytenoid and cricothyroid articulations (SPP 3). The LAR was again calculated after tensioning of each suture separately. Results- With a closed epiglottis, median LAR was 30.0, 20.4, 11.4, and 3.3 cm H2O/L/s at baseline and SPPs 1, 2, and 3, respectively. After UCL at SPP 1, LAR with the epiglottis closed was not significantly different from that at baseline. With an open epiglottis, median LAR was 2.0, 0.4, 0.2, and 0.0 cm H(2)O/L/s at baseline and SPPs 1, 2, and 3, respectively. After UCL at SPPs 1, 2, or 3, LAR with an open epiglottis was significantly lower than that at baseline. Conclusions and Clinical Relevance- Results indicated that placement of suture through the cricoid cartilage at the caudal border of the cricoarytenoid articulation was appropriate to sufficiently reduce LAR without increasing the risk of aspiration pneumonia through overabduction of the arytenoid cartilage.

The objective of this study was to validate, both in vitro and in an ex vivo model, a technique for the measurement of forces exerted on surgical sutures. For this purpose, a stainless steel E-type buckle force transducer was designed and constructed. A strain gauge was mounted on the central beam of the transducer to measure transducer deformation. The transducer was tested and calibrated on a single strand of surgical suture during cyclic loading. Further validation was performed using a previously published cadaveric model of laryngoplasty in the horse. Linear regression of transducer output with actual force during calibration tests resulted in mean R2 values of 1.00, 0.99, and 0.99 for rising slope, falling slope, and overall slope, respectively. The R2 was not less than 0.96 across an average of 75 cycles per test. The difference between rising slope and falling slope was 4%. Over 45 846 samples, the predicted force from transducer output showed a mean error of 4%. In vitro validation produced an adjusted R2 of 0.99 when the force on the suture was regressed against translaryngeal pressure in a mixed-effects model. E-type buckle force transducers showed a highly linear output over a physiological force range when applied to surgical suture in vitro and in an ex vivo model of laryngoplasty. With appropriate calibration and short-term in vivo implantation, these transducers may advance our knowledge of the mechanisms of success and failure of techniques, such as laryngoplasty, that use structural suture implants.

Objective-To develop laparoscopic-assisted techniques for enterostomy feeding tube placement and full-thickness biopsy of the jejunum in dogs. Animals-15 healthy dogs. Procedure-Dogs were anesthetized, and positive pressure ventilation was provided. A trocar cannula for the laparoscope was inserted on the ventral midline caudal to the umbilicus. For enterostomy tube placement, a second trocar cannula was placed lateral to the right rectus abdominis muscle, and a Babcock forceps was used to grasp the duodenum and elevate it to the incision made for the cannula. The duodenum was sutured to the abdominal wall, and a feeding tube was inserted. For jejunal biopsy, a third trocar cannula was placed lateral to the left rectus abdominis muscle. A portion of jejunum was elevated to the incision for the second or third cannula, and a full-thickness biopsy specimen was obtained. A second specimen was obtained from another portion of jejunum, and retention sutures for the 2 biopsy sites were tied so that serosal surfaces of the biopsy sites were apposed to each other. Dogs were euthanatized 30 days after surgery. Results-The enterostomy tube was properly positioned and functional in all 8 dogs that underwent laparoscopic-assisted enterostomy tube placement, and sufficient samples for histologic examination were obtained from all 7 dogs that underwent laparoscopic-assisted jejunal biopsy. None of the dogs had any identifiable problems after surgery. Conclusion and Clinical Relevance-Results suggest that in dogs, laparoscopic-assisted procedures for enterostomy tube placement and jejunal biopsy are an acceptable alternative to procedures performed during a laparotomy.

This study compared the short-term clinical and pathologic effects of spiral and total ring prostheses, applied to the cervical and thoracic portions of the trachea of dogs via a combined intercostal thoracotomy and ventral cervical midline approach. The effect of intraluminal placement of synthetic monofilament nonabsorbable suture also was evaluated. Eleven small-breed dogs were randomly allotted to 3 groups. Group 1 (n = 3) were controls that had been treated by sham operation, group 2 (n = 4) had polypropylene spiral prostheses applied to the cervical and thoracic portions of the trachea, and group 3 (n = 3) had total ring prostheses applied to the cervical and thoracic portions of the trachea. All dogs were euthanatized and necropsied 8 weeks after surgery. Clinical complications were minimal and limited to mild, short-term lameness and coughing. Three and 6 weeks after surgery, radiographs were within normal limits in all dogs. Tracheoscopy confirmed maintenance of tracheal lumen diameter and integrity of the mucosal epithelium in all dogs. Gross and microscopic postmortem findings were similar in groups 2 and 3. Mild adhesions were present between prostheses and adjacent structures. Similar adhesions were present where prostheses had been applied and subsequently removed in group-1 dogs. Histopathologic abnormalities included mild to moderate adventitial and periprosthetic fibrosis and mild adventitial inflammation associated with polypropylene spiral prostheses and total ring prostheses. The majority (70%) of intratracheal sutures evaluated were covered by microscopically normal ciliated mucosal epithelium by 8 weeks after surgery. Polypropylene spiral prostheses and total ring prostheses applied to the cervical and thoracic portions of the trachea of dogs in the manner described appear to be tolerated well and produce a minimal tissue response over the study period.

The objective of this study was to investigate whether cleaning surgical materials used to close pelvic flexure enterotomies with a wet sterile gauze will reduce contamination and whether the use of a full thickness appositional suture pattern (F) or a partial thickness inverting (or Cushing) suture pattern (C) would make a difference in the level of contamination. Large colon specimens were assigned to group F or C and divided into subgroups N and G. In group G, a wet sterile gauze was passed over the suture material, another over the instruments, and another over the gloves. In group N, no treatment was applied. The bacterial concentration was measured by optical density (OD) at 24 h. The OD of subgroup CG was lower than that of subgroup CN (P = 0.019). The OD of subgroup FG was lower than that of subgroup FN (P = 0.02). The OD of subgroups CG, CN, FG, and FN was lower than that of the negative control (P < 0.003, P < 0.001, P < 0.001, and P < 0.00). The use of a sterile wet gauze significantly reduced contamination of suture materials. A partial thickness inverting suture pattern did not produce less contamination than a full thickness appositional suture pattern.