Knotless, absorbable barbed suture devices are a safe and efficacious alternative for cosmetic skin closures and yield wound strength and tissue reaction scores that are comparable to those from closures performed with absorbable monofilament sutures and secured with knots.
In an effort to make laparoscopic suturing more efficient, the V-Loc advanced wound closure device (Covidien, Mansfield, MA) has been produced. This device is a self-anchoring barbed suture that obviates the need for knot tying. The goal of this initial feasibility study was to investigate the use of the barbed suture in gastrointestinal enterotomy closure. A randomized study of 12 pigs comparing enterotomy closure with barbed versus a nonbarbed suture of similar tensile strength was performed. To this end, 25 mm enterotomies were made in the stomach (1 control, 1 treatment), jejunum (2 controls, 2 treatments), and descending colon (1 control, 1 treatment). Animals were killed at 3, 7, and 14 days postoperatively (4 each group) and their gastrointestinal tracts harvested; 6 of the 8 enterotomies from each pig underwent burst strength testing. The remaining 2 were fixed in formalin and sent for histological examination. All 12 pigs survived until they were killed without any major complications. Enterotomy closure with barbed suture revealed adhesion scores, burst strength pressures, and histology scores that were similar to those for the control. Jejunal closures resulted in 6 failures at 7 days (3 control, 3 barbed) and 4 failures at 14 days (2 control, 2 barbed). The barbed suture significantly reduced suturing time in the stomach, jejunum, and colon. The V-Loc wound closure device appears to offer comparable gastrointestinal closure to 3-0 Maxon while being significantly faster. Further studies with V-Loc are required to assess its use in laparoscopic surgery.
Enterotomy closure was faster using the barbed device as compared to conventional suture, with no significant difference in burst strength or adhesion scores at any time point.
SummaryThe purpose of this study was to examine the effect of pin design and drill/pin cooling on the biological response of bone in the near (entry) and far (exit) cortices of mature intact sheep tibiae. Two pins with markedly different characteristics were used; the AO Schanz screw, a traditional pyramidal tipped design, and the fluted, tapered end Howmedica Apex pin. Our hypothesis was that cooling of hardware would reduce thermal necrosis of bone at the pin-bone interface (PBI). When the effect of pin design was controlled for, the cooled pins resulted in better pin bone interfaces at the near cortex but not the far cortex. It is possible that the drill bits and pins warmed significantly after traversing the more vascular bone marrow space, thus the cooling effect was lost before drilling the far cortex. Secondly, the Howmedica Apex pin resulted in more bone at the pin bone interface than the AO Schanz pin indicating that the former’s more advanced design follows the pilot hole and creates threads more accurately, resulting in a better pin-bone fit and less mechanical damage.The purpose of this study was to examine the effects of pin design and drill/pin cooling on the remodelling response of cortical bone at the pin-bone interface in an in vivo sheep tibia model. No significant differences were found between pin designs or between pins that were implanted at 4° C and those that were inserted at 20° C. More bone was retained at the near cortex pin-bone interface (PBI) than the far cortex PBI when the pins were cooled, but the opposite was true when the pins were not cooled.
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