Li, Z.; Zheng, J.; Moskowitz, B. M.; Xiong, Q.; Liu, Q.
Serpentinized mantle peridotites are widely supposed to be significant sources of the magnetic, gravity and seismic anomalies in mid-oceanic ridges, forearcs and suture zones. However, the relationship between the magnetic properties of variably serpentinized peridotites and the serpentinization process is still under debate. Ophiolite outcrops commonly comprise peridotites in different stages of serpentinization and these ophiolitic peridotites are ideal to investigate the magnetic signatures of suture zones. The Zedong ophiolite locates in the eastern part of the Yarlung-Zangbo suture zone, SE Tibet (China), and the peridotite massif represents the remnants of the Neo-Tethyan lithospheric mantle. The harzburgite and lherzolite samples show densities between 3.316 and 2.593 g cm-3, and vary from the freshest to >90% serpentinized peridotites. The magnetic susceptibility curves from room temperature to 700ºC mainly show the Curie temperatures of 585ºC for pure magnetite. The low-temperature (20-300 K) demagnetization curves show the Verwey transitions at 115-125 K, suggesting that magnetite is also the dominant remanence-carrying phase. The hysteresis data of the peridotites fall in the region of pseudo-single-domain (PSD) and follow the theoretical trends for mixtures of single domain (SD) and multidomain (MD) magnetite. The first-order reversal curve (FORC) diagrams suggest that the magnetite is dominantly interacting SD + PSD particles for S < 40%, and SD + PSD + MD particles for the S > 40% serpentinized samples. The susceptibility and saturation magnetization of the Zedong peridotites range from 0.9 to 30.8 × 10‒3 (SI) and 14.1 to 1318 × 10‒3 Am2 kg‒1, respectively, and both show consistent trends with increasing degrees of serpentinization. The S < 40% samples are weakly to moderately magnetic with susceptibilities increasing from 0.001 to 0.02 (SI) and follow the low-temperature serpentinization of ophiolitic peridotites, whereas the S > 40
Guilmette, C.; Hebert, R.; Wang, C.; Indares, A. D.; Ullrich, T. D.; Dostal, J.; Bedard, E.
Metre to decameter-size clasts of amphibolite are found embedded in ophiolitic melanges underlying the Yarlung Zangbo Suture Zone Ophiolites, South Tibet, China. These ophiolites and melanges occur at the limit between Indian and Tibetan-derived rocks and represent remnants of an Early Cretaceous intraoceanic supra-subduction zone domain, the Neo-Tethys. In the Saga-Dazuka segment (500 km along-strike), we discovered new occurrences of strongly foliated amphibolites found as clasts in the ophiolitic melange. In garnet-free samples, hornblende is green-blue magnesio-hornblende and cpx is low-Al diopside. In garnet- bearing samples, garnet is almandine with a strong pyrope component (up to 30 mol%) whereas coexisting hornblende is brown Ti-rich tschermakite and clinopyroxene is Al-diopside. Plagioclase composition was ubiquitously shifted to albite during a late metasomatic event. Geochemistry of these rocks indicates that their igneous protoliths crystallized from a slightly differentiated tholeiitic basaltic liquid that did not undergo major fractionation. Trace element patterns reveal geochemical characteristics identical to those of the overlying ophiolitic crust. These are 1) trace element abundances similar to that of N-MORBs or BABBs, 2) a slight depletion of LREE and 3) a moderate to strong Ta-Nb negative anomaly and a slight Ti anomaly. Such characteristics suggest genesis over a spreading center close to a subduction zone, possibly a back-arc basin. Step-heating Ar/Ar plateau ages were obtained from hornblende separates. All ages fall in the range of 123-128 Ma, overlapping the crystallization ages from the overlying ophiolite (126-131 Ma). Pseudosections were built with the THERMOCALC software in the system NCFMASH. Results indicate that the observed assemblage Hb+Pl+Gt+Cpx is stable over a wide range of P-T conditions, between 10-18 kbars and at more than 800°C. Measured mineral modes and solid solution compositions were successfully modeled, indicating
Dupuis, C.; Hebert, R.; Wang, C.; Li, Y.; Li, Z.
Located north of the Himalayas, the E-W trending YZSZ is mainly composed of remnants of the Neo-Tethys ocean-floor and marks the suture between Indian and Eurasian plates. This project aims to define geological units immediately South of the YZSZ ophiolites : the serpentinized ophiolitic mélange, the Jurassic-Cretaceous wildflysch and the Triassic flysch. The ophiolitic mélange is characterized by ultramafic rocks, which can be divided into 3 groups. Cpx-harzburgites contain brownish aluminous spinels with Mg# of 0.7-0.75 and Cr# of 0.15-0.27. They resemble fertile abyssal peridotites with generally smooth LREE-depleted and fairly flat MREE-HREE profiles. Transitional harzburgites contain reddish spinels with Mg# of 0.57-0.66 and Cr# of 0.35-0.46. They resemble depleted abyssal or supra-subduction zone peridotites in that MREE-HREE profiles have positive slopes indicative of high degrees of partial melting. LREE profiles vary from depleted to slightly enriched, consistent with some trapped or interacting melt or aqueous fluids. Harzburgites and dunites contain dark reddish spinels with Mg# of 0.47-0.68 and Cr# of 0.40-0.63. They have U-shaped profiles characteristics of interaction between LREE-enriched melt and REE-depleted mantle residues. Spinel compositions and fractional melting modelling indicate that Cpx-harburgites may be the residues from 5-15% melting, transitional harzburgites from 15-23% melting, and harzburgites and dunites from 22-29% melting. The South Sandwich arc-basin system is considered a modern analog of initial geodynamic setting. Mafic rocks (gabbros, diabases and basalts) are ubiquitous and can be geochemically subdivided according to their source unit. LREE-depleted profiles with average (La/Yb)N of 0.5 and slight negative Nb-Ta and Ti anomalies indicate that rocks from the ophiolitic mélange formed in a back-arc basin, such as back-arc-basin mafic rocks of the Izu-Bonin Arc. REE patterns of rocks from the wildflysch are LREE
Xie, Y.; Dilek, Y.
The Liuqu Conglomerate (LQC) along the Yarlung-Zangbo suture zone (YZSZ) in Southern Tibet is a terrestrial deposit that provides significant spatial and temporal constraints for the timing and nature of collisional events in the tectonic evolution of the Tibetan-Himalayan orogenic belt. The 10-km-wide (N-S) LQC is exposed discontinuously for more than 1000 km in an E-W direction, and is tectonically overlain to the north by the Cretaceous Neotethyan oceanic lithosphere along a S-vergent thrust fault system and to the south by Triassic-Jurassic metamorphosed sedimentary-volcanic rocks of the Tethyan Himalaya along N-vergent reverse-thrust faults. The major facies of the LQC are the matrix-supported to clast-supported conglomerates. The matrix is poorly to moderate sorted red quartz sandstone, mudstone and sub-rounded pebble to cobble-sized clasts. The clast lithology present in central and southern parts includes dark red sandstone, siltstone and mudstone greyish-green shale, grey phyllite and slate with their provenance in the Triassic Tethyan Himalaya to the south. The clastic material making up its stratigraphy in the northern part of the LQC includes quartz sandstone, radiolarian chert, minor dolerite, gabbro and peridotite derived from the Cretaceous ophiolite. Here we report in-situ detrital zircon U-Pb age analysis of sandstone from the LQC near Liuqu area. 163 concordant U-Pb ages obtained from sample 22-LQ-15, 27-LQ-15 and 35-LQ-15 show the youngest age is 307±13 Ma with discordance of -17.02%, and the oldest zircon grain is 3362 ±51 Ma with discordance of 2.63%. Statistically, the age spectrum of these zircons from the three sandstone samples display a prominent peak centred in 935 Ma, a large peak around 516 Ma, and two small clusters around 2429 Ma and 2772 Ma. The zircon U-Pb results provide evidence of age clusters of the sandstone in LQC are consistent with the detrital U-Pb age signature of the sandstone in Tethyan Himalaya. Thus, the sediments in
Li, Kang; Xu, Xiwei; Kirby, Eric; Tang, Fangtou; Kang, Wenjun
How the eastward motion of crust in the central Tibetan Plateau is accommodated in the remote regions of the eastern Himalayan syntaxis remains uncertain. Although the Yarlung Zangbo suture (YZS) forms a striking lineament in the topography of the region, evidence for recent faulting along this zone has been equivocal. To understand whether faults along the YZS are active, we performed a geological investigation along the eastern segments of the YZS. Geomorphic observations suggest the presence of active faulting along several segments of the YZS, which we collectively refer to as the "Milin fault". Paleoseismologic data from trenches reveal evidence for one faulting event, which is constrained to occur between 5620 and 1945 a BP. The latest faulting event displaced alluvial surface T2 by 7 m. The offset on this earthquake place the minimum value on the vertical slip rate of 0.3 mm/yr. Empirical relationships between surface rupture length, displacement and magnitude, suggest that magnitude of the latest event could have been Mw 7.3-7.7. On the basis of this slip rate and the elapsed time since the last event, it is estimated that a seismic moment equivalent to Mw 7.0 has been accumulated on the Milin fault. It is pose a threat to the surrounding region. Our results suggest that shortening occurs in the vicinity of the eastern Himalayan syntaxis, and part of eastward motion of crust from the central Tibetan Plateau is absorbed by uplift of the eastern Himalayan syntaxis.
An, Wei; Hu, Xiumian; Garzanti, Eduardo
The Xiukang Mélange of the Yarlung-Zangbo suture zone in south Tibet documents low efficiency of accretion along the southern active margin of Asia during Cretaceous Neotethyan subduction, followed by final development during the early Paleogene stages of the India-Asia collision. Here we investigate four transverses in the Xigaze area (Jiding, Cuola Pass, Riwuqi and Saga), inquiry the composition in each transverse, and present integrated petrologic, U-Pb detrital-zircon geochronology and Hf isotope data on sandstone blocks. In fault contact with the Yarlung-Zangbo Ophiolite to the north and the Tethyan Himalaya to the south, the Xiukang mélange can be divided into three types: serpentinite-matrix mélange composed by broken Yarlung-Zangbo Ophiolite, thrust-sheets consisting mainly chert, quartzose or limestone sheets(>100m) with little intervening marix, and mudstone-matrix mélange displaying typical blocks-in-matrix texture. While serpentinite-matrix mélange is exposed adjacent to the ophiolite, distributions of thrust-sheets and blocks in mudstone-matrix mélange show along-strike diversities. For example, Jiding transverse is dominant by chert sheets and basalt blocks with scarcely sandstone blocks, while Cuola Pass and Saga transverses expose large amounts of limestone/quartzarenite sheets in the north and volcaniclastic blocks in the south. However, turbidite sheets and volcaniclastic blocks are outcropped in the north Riwuqi transverse with quartzarenite blocks preserved in the south. Three groups of sandstone blocks/sheets with different provenance and depositional setting are distinguished by their petrographic, geochronological and isotopic fingerprints. Sheets of turbiditic quartzarenite originally sourced from the Indian continent were deposited in pre-Cretaceous time on the northernmost edge of the Indian passive margin and eventually involved into the mélange at the early stage of the India-Asia collision. Two distinct groups of volcaniclastic
Gao, R.; Li, W.; Guo, X.; Li, H.; Lu, Z.; He, R.; Zeng, L.; Klemperer, S. L.; Huang, X.
The Tibetan plateau was created by continental collision between India and Eurasia and their ongoing convergence. The extent of subduction of Indian crust is central to our understanding the geodynamics of continental collision. However, owing to the lack of high-resolution data on the crustal-scale geometry of the Himalayan collision zone, the thickness of Indian crust subducting beneath the Yarlung-Zangbo Suture has been poorly known. Here we present two new deep seismic reflection profiles, respectively 100-km and 60-km long, across the central part of the Yarlung-Zangbo suture at c. 88°E (Figure 1). Seismic data processing used the CGG, ProMAX, and GeoEast systems. Processing included tomographic static correction, true-amplitude recovery, frequency analysis, filter-parameter tests, surface-consistent-amplitude corrections, surface-consistent deconvolution, coherent noise suppression, random noise attenuation, human-computer interactive velocity analysis, residual statics correction, Kirchhoff pre-stack time migration incorporating the rugged topography, and post-stack polynomial fitting to remove noise. Our two profiles both trace the Main Himalayan Thrust continuously from the mid-crust to deep beneath southern Tibet. Together with prominent Moho reflections at the base of the double-normal-thickness crust, the geometry of the subducting Indian crust is well defined. Both profiles image a limited extent of the Indian crust beneath southern Tibet and indicate that north-dipping Indian crust and south-dipping Lhasa crust converge beneath the Xietongmen region, above the remnant mantle suture. Figure 1. Geological map of the Xietongmen Region, south Tibet. The deep seismic reflection profile is shown as a solid red line, the location of big shots are shown as black stars.
Gao, R.; Li, H.; Li, W.; Lu, Z.; Guo, X.; WANG, Y.
The YZS (Yarlung Zangbo Suture) is the collisional front between the Indian and Eurasian plates. The depth and geometry of the Moho thus provide first-order information for the restoration of complex geodynamic systems. Over the past three decades, numerous seismic experiments have been conducted across the YZS, including deep seismic reflection profiles, deep seismic soundings and broadband observation studies. However, there is strong disagreement concerning the character of the Moho along the YZS in Tibet. Hirn proposed an offset of more than 15 km along the Moho below the YZS according to wide-angle observations acquired by a Sino-French cooperative experiment. Jiang argued that the Moho exhibits a 20-km offset after analyzing multiple broadband seismic profiles across the YZS. Gao did not find any significant changes in the Moho depth using deep seismic reflection profile data across the western YZS. The above mentioned summary of previous findings shows that similar geophysical observations have yielded contrasting models. Due to the shortage of high-resolution geophysical data, the above controversial problems cannot currently be resolved effectively without improving the accuracy of available geophysical observations and consequently obtaining reliable evidence. The rapid development of the technology of deep seismic reflection profiling has provided an opportunity to resolve the above controversies. two deep seismic reflection profiles across the YZS(88°E) were deployed in 2015(Fig .1 -YZS-B). Four large dynamite shots with 2000 kg charges were employed to improve the signal-to-noise ratio (S/N) along the two transects(Fig .1 and Fig.2). The primary purpose of this experiment is to study images of the Moho both adjacent to and beneath the YZS using four large dynamite shots along two profiles. These four large shots were processed to combine two single-fold profiles. Our two single-fold profiles across the YZS clearly show the existence of a well
Moritz, C.; Hoskin, C.J.; MacKenzie, J.B.; Phillips, B.L.; Tonione, M.; Silva, N.; VanDerWal, J.; Williams, S.E.; Graham, C.H.
Suture zones, shared regions of secondary contact between long-isolated lineages, are natural laboratories for studying divergence and speciation. For tropical rainforest, the existence of suture zones and their significance for speciation has been controversial. Using comparative phylogeographic evidence, we locate a morphologically cryptic suture zone in the Australian Wet Tropics rainforest. Fourteen out of 18 contacts involve morphologically cryptic phylogeographic lineages, with mtDNA sequence divergences ranging from 2 to 15 per cent. Contact zones are significantly clustered in a suture zone located between two major Quaternary refugia. Within this area, there is a trend for secondary contacts to occur in regions with low environmental suitability relative to both adjacent refugia and, by inference, the parental lineages. The extent and form of reproductive isolation among interacting lineages varies across species, ranging from random admixture to speciation, in one case via reinforcement. Comparative phylogeographic studies, combined with environmental analysis at a fine-scale and across varying climates, can generate new insights into suture zone formation and to diversification processes in species-rich tropical rainforests. As arenas for evolutionary experimentation, suture zones merit special attention for conservation. PMID:19203915
Johnson, P.R.; Kattan, F.
The Hulayfah-Ad Dafinah-Ruwah fault zone is a belt of highly strained rocks that extends in a broad curve across the northeastern Arabian shield. It is a subvertical shear zone, 5-30 km wide and over 600 km long, and is interpreted as a zone of oblique sinistral transpression that forms the suture between the Afif terrane and the Asir-Jiddah-Hijaz-Hulayfah superterrane. Available data suggest that the terranes began to converge sometime after 720 Ma, were in active contact at about 680 Ma, and were in place, with suturing complete, by 630 Ma, The fault zone was affected by sinistral horizontal and local vertical shear, and simultaneous flattening and fault-zone-parallel extension. Structures include sinistral sense-of-shear indicators, L-S tectonite, and coaxial stretching lineations and fold axes. The stretching lineations switch from subhorizontal to subvertical along the fault zone indicating significant variation in finite strain consistent with an origin by oblique transpression. The sense of shear on the fault zone suggests sinistral trajectories for the converging terranes, although extrapolating the shear sense of the suture zone to infer far-field motion must be done with caution. The amalgamation model derived from the chronologic and structural data for the fault zone modifies an existing model of terrane amalgamation and clarifies the definitions of two deformational events (the Nabitah orogeny and the Najd fault system) that are widely represented in the Arabian shield. ?? 2001 Elsevier Science B.V.
Lytwyn, Jennifer; Burke, Kevin; Culver, Stephen
The boundaries of the West African Craton mark the location of a continuous suture zone that records Neoproterozoic to Early Cambrian oceanic closure. The western part of the circum-West African suture zone extends through the line of outcrop of the Mauritanide, Bassaride and Rokelide mountain belts. Our geochemical analyses are consistent with the idea that igneous and metamorphic rocks of the Rokelide and Southern Mauritanide mountain belts of West Africa occupy a suture zone that records the closing of a Neoproterozoic to Early Cambrian ocean basin during the Pan-African orogeny and final assembly of Gondwana. The closing of that basin was marked by the collision between Archean rocks of the Leo massif of the West African Craton and reactivated Archean and Paleoproterozoic rocks that now outcrop nearer to the coast of Africa in Sierra Leone and Liberia. Within the Rokelides, the geochemistry of the Kasewe Hills volcanic rocks and Marampa amphibolite indicate that remnants of an arc system are caught up in the suture zone. The geochemistry of Guingan schists that outcrop along strike of the Rokelides is compatible with the idea that the metamorphosed equivalents of the Marampa and Kasewe Hills arc volcanic rocks extend through the Bassarides and into the Southern Mauritanides.
Buckley, Christina E; Kavanagh, Dara O; Nugent, Emmeline; Ryan, Donncha; Traynor, Oscar J; Neary, Paul C
Simulator performance is measured by metrics, which are valued as an objective way of assessing trainees. Certain procedures such as laparoscopic suturing, however, may not be suitable for assessment under traditionally formulated metrics. Our aim was to assess if our new metric is a valid method of assessing laparoscopic suturing. A software program was developed to order to create a new metric, which would calculate the percentage of time spent operating within pre-defined areas called "zones." Twenty-five candidates (medical students N = 10, surgical residents N = 10, and laparoscopic experts N = 5) performed the laparoscopic suturing task on the ProMIS III(®) simulator. New metrics of "in-zone" and "out-zone" scores as well as traditional metrics of time, path length, and smoothness were generated. Performance was also assessed by two blinded observers using the OSATS and FLS rating scales. This novel metric was evaluated by comparing it to both traditional metrics and subjective scores. There was a significant difference in the average in-zone and out-zone scores between all three experience groups (p < 0.05). The new zone metrics scores correlated significantly with the subjective-blinded observer scores of OSATS and FLS (p = 0.0001). The new zone metric scores also correlated significantly with the traditional metrics of path length, time, and smoothness (p < 0.05). The new metric is a valid tool for assessing laparoscopic suturing objectively. This could be incorporated into a competency-based curriculum to monitor resident progression in the simulated setting.
Williams, Jackie M.; Rodriguez, Brian D.
It is important to know whether major mining districts in the Northern Nevada Gold Province are underlain by rocks of the Archean Wyoming craton, which are known to contain orogenic gold deposits, or by accreted rocks of the Paleoproterozoic Mojave province. It is also important to know the location and orientation of the Archean/Proterozoic suture zone between these provinces as well as major basement structures within these terranes because they may influence subsequent patterns of sedimentation, deformation, magmatism, and hydrothermal activity. The Archean was the main gold-mineralization period, and Archean lode-gold deposits were formed at mid-crustal depths along major shear zones. The nature of the crystalline basement below the Northern Nevada Gold Province and the location of major faults within it are relevant to Rodinian reconstructions, crustal development, and ore deposit models (e.g., Hofstra and Cline, 2000; Grauch and others, 2003). According to Whitmeyer and Karlstrom (2004), the Archean cratons of the northwestern United States and Canada had stabilized as continental lithosphere by 2.5 Ga, and were rifted and assembled into a large continental mass by 1.8 Ga, to which the 1.73-1.68 Ga Mohave province was accreted by 1.65 Ga. The Archean/Proterozoic suture zone has a west-southwest strike where it is exposed (Reed, 1993) at the eastern Utah and southwestern Wyoming border (Cheyenne Belt) where it is characterized by an up to 7-km-thick mylonite zone (Smithson and Boyd, 1998). In the Great Basin, the strike of the Archean/Proterozoic suture zone is poorly constrained because it is largely concealed below a Neoproterozoic-Paleozoic miogeocline and basin fill. East-west and southwest-northeast strikes for the Archean/Proterozoic suture zone have been inferred based on Sr, Nd, and Pb isotopic compositions of granitoid intrusions (Tosdal and others, 2000). To better constrain the location and strike of the Archean/Proterozoic suture zone below cover
Robertson, Alastair H. F.; Collins, Alan S.
The Shyok Suture Zone (Northern Suture) of North Pakistan is an important Cretaceous-Tertiary suture separating the Asian continent (Karakoram) from the Cretaceous Kohistan-Ladakh oceanic arc to the south. In previously published interpretations, the Shyok Suture Zone marks either the site of subduction of a wide Tethyan ocean, or represents an Early Cretaceous intra-continental marginal basin along the southern margin of Asia. To shed light on alternative hypotheses, a sedimentological, structural and igneous geochemical study was made of a well-exposed traverse in North Pakistan, in the Skardu area (Baltistan). To the south of the Shyok Suture Zone in this area is the Ladakh Arc and its Late Cretaceous, mainly volcanogenic, sedimentary cover (Burje-La Formation). The Shyok Suture Zone extends northwards (ca. 30 km) to the late Tertiary Main Karakoram Thrust that transported Asian, mainly high-grade metamorphic rocks southwards over the suture zone. The Shyok Suture Zone is dominated by four contrasting units separated by thrusts, as follows: (1). The lowermost, Askore amphibolite, is mainly amphibolite facies meta-basites and turbiditic meta-sediments interpreted as early marginal basin rift products, or trapped Tethyan oceanic crust, metamorphosed during later arc rifting. (2). The overlying Pakora Formation is a very thick (ca. 7 km in outcrop) succession of greenschist facies volcaniclastic sandstones, redeposited limestones and subordinate basaltic-andesitic extrusives and flow breccias of at least partly Early Cretaceous age. The Pakora Formation lacks terrigenous continental detritus and is interpreted as a proximal base-of-slope apron related to rifting of the oceanic Ladakh Arc; (3). The Tectonic Melange (<300 m thick) includes serpentinised ultramafic rocks, near mid-ocean ridge-type volcanics and recrystallised radiolarian cherts, interpreted as accreted oceanic crust. (4). The Bauma-Harel Group (structurally highest) is a thick succession (several km
Chetty, T. R. K.; Yellappa, T.; Santosh, M.
The Cauvery suture zone (CSZ) in southern India has witnessed multiple deformations associated with multiple subduction-collision history, with incorporation of the related accretionary belts sequentially into the southern continental margin of the Archaean Dharwar craton since Neoarchean to Neoproterozoic. The accreted tectonic elements include suprasubduction complexes of arc magmatic sequences, high-grade supracrustals, thrust duplexes, ophiolites, and younger intrusions that are dispersed along the suture. The intra-oceanic Neoarchean-Neoproterozoic arc assemblages are well exposed in the form of tectonic mélanges dominantly towards the eastern sector of the CSZ and are typically subjected to complex and multiple deformation events. Multi-scale analysis of structural elements with detailed geological mapping of the sub-regions and their structural cross sections, geochemical and geochronological data and integrated geophysical observations suggest that the CSZ is an important zone that preserves the imprints of multiple cycles of Precambrian plate tectonic regimes.
Rodriguez, B.D.; Williams, J.M.
It is important to know whether major mining districts in north-central Nevada are underlain by crust of the Archean Wyoming craton, known to contain major orogenic gold deposits or, alternatively, by accreted crust of the Paleoproterozoic Mojave province. Determining the location and orientation of the Archean-Proterozoic suture zone between these provinces is also important because it may influence subsequent patterns of sedimentation, deformation, magmatism, and hydrothermal activity. The suture zone is exposed in northeastern Utah and south-western Wyoming and exhibits a southwest strike. In the Great Basin, the suture zone strike is poorly constrained because it is largely concealed below a Neoproterozoic-Paleozoic miogeocline and Cenozoic basin fill. Two-dimensional resistivity modeling of three regional north-south magnetotelluric sounding profiles in western Utah, north-central Nevada, and northeastern Nevada, and one east-west profile in northeastern Nevada, reveals a deeply penetrating (>10 km depth), broad (tens of kilometers) conductor (1-20 ohm-meters) that may be the Archean-Proterozoic suture zone, which formed during Early Proterozoic rifting of the continent and subsequent Proterozoic accretion. This major crustal conductor changes strike direction from southwest in Utah to northwest in eastern Nevada, where it broadens to ???100 km width that correlates with early Paleozoic rifting of the continent. Our results suggest that the major gold belts may be over-isolated blocks of Archean crust, so Phanerozoic mineral deposits in this region may be produced, at least in part, from recycled Archean gold. Future mineral exploration to the east may yield large gold tonnages. ?? 2008 Geological Society of America.
McGrath, Daniel; Steffen, Konrad; Holland, Paul R.; Scambos, Ted; Rajaram, Harihar; Abdalati, Waleed; Rignot, Eric
Ice shelf fractures frequently terminate where they encounter suture zones, regions of material heterogeneity that form between meteoric inflows in ice shelves. This heterogeneity can consist of marine ice, meteoric ice with modified rheological properties, or the presence of fractures. Here, we use radar observations on the Larsen C Ice Shelf, Antarctica, to investigate (i) the termination of a 25 km long rift in the Churchill Peninsula suture zone, which was found to contain 60 m of accreted marine ice, and (ii) the along-flow evolution of a suture zone originating at Cole Peninsula. We determine a steady state field of basal melting/freezing rates and apply it to a flowline model to delineate the along-flow evolution of layers within the ice shelf. The thickening surface wedge of locally accumulated meteoric ice, which likely has limited lateral variation in its mechanical properties, accounts for 60% of the total ice thickness near the calving front. Thus, we infer that the lower 40% of the ice column and the material heterogeneities present there are responsible for resisting fracture propagation and thereby delaying tabular calving events, as demonstrated in the >40 year time series leading up to the 2004/2005 calving event for Larsen C. This likely represents a highly sensitive aspect of ice shelf stability, as changes in the oceanic forcing may lead to the loss of this heterogeneity.
Motaghi, K.; Shabanian, E.; Kalvandi, F.
A 2-D absolute shear wave velocity model has been resolved beneath a seismic profile across the northeastern margin of the Arabian Plate-Central Iran by simultaneously inverting data from P receiver functions and fundamental mode Rayleigh wave phase velocity. The data were gathered by a linear seismic array crossing the Zagros fold and thrust belt, Urmia-Dokhtar magmatic arc and Central Iran block assemblage as three major structural components of the Arabia-Eurasia collision. Our model shows a low-velocity tongue protruding from upper to lower crust which, north of the Zagros suture, indicates the signature of an intracontinent low-strength shear zone between the underthrusting and overriding continents. The velocity model confirms the presence of a significant crustal root as well as a thick high-velocity lithosphere in footwall of the suture, continuing northwards beneath the overriding continent for at least 200 km. These features are interpreted as underthrusting of Arabia beneath Central Iran. Time to depth migration of P receiver functions reveals an intracrustal flat interface at ∼17 km depth south of the suture; we interpret it as a significant decoupling within the upper crust. All these crustal scale structural features coherently explain different styles and kinematics of deformation in northern Zagros (Lorestan zone) with respect to its southern part (Fars zone).
Knapmeyer-Endrun, Brigitte; Krüger, Frank; Legendre, Cedric P.; Geissler, Wolfram H.
Cratons with their thick lithospheric roots can influence the thermal structure, and thus the convective flow, in the surrounding mantle. As mantle temperatures are hard to measure directly, depth variations in the mantle transition zone (MTZ) discontinuities are often employed as a proxy. Here, we use a large new data set of P-receiver functions to map the 410 km and 660 km discontinuities beneath the western edge of the East European Craton and adjacent Phanerozoic Europe across the most fundamental lithospheric boundary in Europe, the Trans-European Suture Zone (TESZ). We observe significantly shorter travel times for conversions from both MTZ discontinuities within the craton, caused by the high velocities of the cratonic root. By contrast, the differential travel time across the MTZ is normal to only slightly raised. This implies that any insulating effect of the cratonic keel does not reach the MTZ. In contrast to earlier observations in Siberia, we do not find any trace of a discontinuity at 520 km depth, which indicates a rather dry MTZ beneath the western edge of the craton. Within most of covered Phanerozoic Europe, the MTZ differential travel time is remarkably uniform and in agreement with standard Earth models. No widespread thermal effects of the various episodes of Caledonian and Variscan subduction that took place during the amalgamation of the continent remain. Only more recent tectonic events, related to Alpine subduction and Quarternary volcanism in the Eifel area, can be traced. While the East European craton shows no distinct imprint into the MTZ, we discover the signature of the TESZ in the MTZ in the form of a linear region of about 350 km width with a 1.5 s increase in differential travel time, which could either be caused by high water content or decreased temperature. Taking into account results of recent S-wave tomographies, raised water content in the MTZ cannot be the main cause for this observation. Accordingly, we explain the increase
Knapmeyer-Endrun, B.; Krüger, F.; Legendre, C. P.; Geissler, W. H.; PASSEQ Working Group; Wilde-Piórko, M.; Geissler, W. H.; Plomerová, J.; Grad, M.; Babuška, V.; Brückl, E.; Cyziene, J.; Czuba, W.; England, R.; Gaczyński, E.; Gazdova, R.; Gregersen, S.; Guterch, A.; Hanka, W.; Hegedüs, E.; Heuer, B.; Jedlička, P.; Lazauskiene, J.; Keller, G. R.; Kind, R.; Klinge, K.; Kolinsky, P.; Komminaho, K.; Kozlovskaya, E.; Krüger, F.; Larsen, T.; Majdański, M.; Malek, J.; Motuza, G.; Novotný, O.; Pietrasiak, R.; Plenefisch, T.; Růžek, B.; Sliaupa, S.; Środa, P.; Świeczak, M.; Tiira, T.; Voss, P.; Wiejacz, P.
Cratons with their thick lithospheric roots can influence the thermal structure, and thus the convective flow, in the surrounding mantle. As mantle temperatures are hard to measure directly, depth variations in the mantle transition zone (MTZ) discontinuities are often employed as a proxy. Here, we use a large new data set of P-receiver functions to map the 410 km and 660 km discontinuities beneath the western edge of the East European Craton and adjacent Phanerozoic Europe across the most fundamental lithospheric boundary in Europe, the Trans-European Suture Zone (TESZ). We observe significantly shorter travel times for conversions from both MTZ discontinuities within the craton, caused by the high velocities of the cratonic root. By contrast, the differential travel time across the MTZ is normal to only slightly raised. This implies that any insulating effect of the cratonic keel does not reach the MTZ. In contrast to earlier observations in Siberia, we do not find any trace of a discontinuity at 520 km depth, which indicates a rather dry MTZ beneath the western edge of the craton. Within most of covered Phanerozoic Europe, the MTZ differential travel time is remarkably uniform and in agreement with standard Earth models. No widespread thermal effects of the various episodes of Caledonian and Variscan subduction that took place during the amalgamation of the continent remain. Only more recent tectonic events, related to Alpine subduction and Quarternary volcanism in the Eifel area, can be traced. While the East European craton shows no distinct imprint into the MTZ, we discover the signature of the TESZ in the MTZ in the form of a linear region of about 350 km width with a 1.5 s increase in differential travel time, which could either be caused by high water content or decreased temperature. Taking into account results of recent S-wave tomographies, raised water content in the MTZ cannot be the main cause for this observation. Accordingly, we explain the increase
Mohanty, D. P.; Chetty, T. R. K.
Existence of a possible detachment zone at Elampillai region, NW margin of Kanjamalai Hills, located in the northern part of Cauvery Suture Zone (CSZ), Southern India, is reported here for the first time. Detailed structural mapping provides anatomy of the zone, which are rarely preserved in Precambrian high grade terranes. The detachment surface separates two distinct rock units of contrasting lithological and structural characters: the upper and lower units. The detachment zone is characterized by a variety of fold styles with the predominance of tight isoclinal folds with varied plunge directions, limb rotations and the hinge line variations often leading to lift-off fold like geometries and deformed sheath folds. Presence of parasitic folding and associated penetrative strains seem to be controlled by differences in mechanical stratigraphy, relative thicknesses of the competent and incompetent units, and the structural relief of the underlying basement. Our present study in conjunction with other available geological, geochemical and geochronological data from the region indicates that the structures of the detachment zone are genetically related to thrust tectonics forming a part of subduction-accretion-collision tectonic history of the Neoproterozoic Gondwana suture.
Knapmeyer-Endrun, B.; Krueger, F.
The depth to which lithospheric roots of cratons influence the surrounding mantle has important consequences for our understanding of the thermal structure of the mantle and its geodynamics. For example, it has been proposed that the cratonic keel of the Kaapvaal craton extends even into the mantle transition zone (MTZ). Here, we use more than 19,000 P-receiver functions from 479 stations in central and eastern Europe to map the MTZ discontinuities beneath the western boundary of the East European Craton (EEC) and adjacent Phanerozoic Europe, across the Trans-European Suture Zone (TESZ), the most fundamental lithospheric boundary in Europe. The main data source in our study is the PASSEQ experiment, which achieved the densest coverage across the TESZ yet with about 200 temporary stations installed from 2006 to 2008 in Germany, the Czech Republic, Poland and Lithuania. These recordings are supplemented by national and regional networks and broad-band data from older temporary deployments. Receiver functions use P-to-S converted teleseismic waves, which yield relative travel times to the 410 km and 660 km discontinuities. They are especially useful in mapping variations in MTZ thickness. We observe significantly shorter travel times, by as much as 2 s compared to standard Earth models, for conversions from both MTZ discontinuities within the craton. This is an effect of the cratonic root and can be explained by about 5% higher velocities in the upper mantle, compared to IASP91, beneath the craton. By contrast, the differential travel time across the MTZ is normal to slightly raised. This implies that any insulating effect of the continental root does not reach the MTZ, comparable to recent observations for the North American Craton. In contrast to earlier observations in Siberia, we do not find any trace of a discontinuity at 520 km depth. If this discontinuity is caused by the transition of wadsleyite to ringwoodite, this means that the MTZ is rather dry beneath the
Laskowski, Andrew K.; Kapp, Paul; Ding, Lin; Campbell, Clay; Liu, XiaoHui
The Lopu Range, located 600 km west of Lhasa, exposes a continental high-pressure metamorphic complex beneath India-Asia (Yarlung) suture zone assemblages. Geologic mapping, 14 detrital U-Pb zircon (n = 1895 ages), 11 igneous U-Pb zircon, and nine zircon (U-Th)/He samples reveal the structure, age, provenance, and time-temperature histories of Lopu Range rocks. A hornblende-plagioclase-epidote paragneiss block in ophiolitic mélange, deposited during Middle Jurassic time, records Late Jurassic or Early Cretaceous subduction initiation followed by Early Cretaceous fore-arc extension. A depositional contact between fore-arc strata (maximum depositional age 97 ± 1 Ma) and ophiolitic mélange indicates that the ophiolites were in a suprasubduction zone position prior to Late Cretaceous time. Five Gangdese arc granitoids that intrude subduction-accretion mélange yield U-Pb ages between 49 and 37 Ma, recording Eocene southward trench migration after collision initiation. The south dipping Great Counter Thrust system cuts older suture zone structures, placing fore-arc strata on the Kailas Formation, and sedimentary-matrix mélange on fore-arc strata during early Miocene time. The north-south, range-bounding Lopukangri and Rujiao faults comprise a horst that cuts the Great Counter Thrust system, recording the early Miocene ( 16 Ma) transition from north-south contraction to orogen-parallel (E-W) extension. Five early Miocene (17-15 Ma) U-Pb ages from leucogranite dikes and plutons record crustal melting during extension onset. Seven zircon (U-Th)/He ages from the horst block record 12-6 Ma tectonic exhumation. Jurassic—Eocene Yarlung suture zone tectonics, characterized by alternating episodes of contraction and extension, can be explained by cycles of slab rollback, breakoff, and shallow underthrusting—suggesting that subduction dynamics controlled deformation.
Kuntz, Mel A.; Snee, Lawrence W.
The papers in this volume describe petrologic, structural, and geochemical studies related to geographic areas adjacent to and including the Salmon River suture zone. We therefore start this volume by defining and giving a general description of that suture zone. The western margin of the North American continent was the setting for complex terrane accretion and large-scale terrane translation during Late Cretaceous and Eocene time. In western Idaho, the boundary that separates the Paleozoic-Mesozoic accreted oceanic, island-arc rocks on the west from Precambrian continental metamorphic and sedimentary rocks on the east is called the Salmon River suture zone (SRSZ). Readers will note that the term 'Salmon River suture zone' is used in the title of this volume and in the text of several of the papers and the term 'western Idaho suture zone' is used in several other papers in this volume. Both terms refer to the same geologic feature and reflect historical usage and custom; thus no attempt has been made by the editors to impose or demand a single term by the various authors of this volume. The suture zone is marked by strong lithologic and chemical differences. Rocks adjacent to the suture zone are characterized by high-grade metamorphism and much structural deformation. In addition, the zone was the locus of emplacement of plutons ranging in composition from tonalite to monzogranite during and after the final stages of accretion of the oceanic terrane to the North American continent. The contents of this paper consists of seven chapters.
Dasmahapatra, Kanchon K; Lamas, Gerardo; Simpson, Fraser; Mallet, James
Attempts by biogeographers to understand biotic diversification in the Amazon have often employed contemporary species distribution patterns to support particular theories, such as Pleistocene rainforest refugia, rather than to test among alternative hypotheses. Suture zones, narrow regions where multiple contact zones and hybrid zones between taxa cluster, have been seen as evidence for past expansion of whole biotas that have undergone allopatric divergence in vicariant refuges. We used coalescent analysis of mutilocus sequence data to examine population split times in 22 pairs of geminate taxa in ithomiine and heliconiine butterflies. We test a hypothesis of simultaneous divergence across a suture zone in NE Peru. Our results reveal a scattered time course of diversification in this suture zone, rather than a tight cluster of split times. Additionally, we find rapid diversification within some lineages such as Melinaea contrasting with older divergence within lineages such as the Oleriina (Hyposcada and Oleria). These results strongly reject simple vicariance as a cause of the suture zone. At the same time, observed lineage effects are incompatible with a series of geographically coincident vicariant events which should affect all lineages similarly. Our results suggest that Pleistocene climatic forcing cannot readily explain this Peruvian suture zone. Lineage-specific biological traits, such as characteristic distances of gene flow or varying rates of parapatric divergence, may be of greater importance. © 2010 Blackwell Publishing Ltd.
Selverstone, Jane; Wernicke, Brian P.; Aliberti, Elaine A.
The Salmon River suture zone in west central Idaho juxtaposes volcanic arc rocks of the Wallowa terrane directly against cratonic North America. Detailed metamorphic studies along a 10 km traverse perpendicular to the suture indicate that the arc and two crystalline fragments thrust upon it each record different pressure-temperature (P-T) histories. From lowest to highest structural level: the Wallowa terrane shows only subgreenschist metamorphism, the Rapid River plate (RRP) records unroofing and cooling from ˜8 kbar and 550°C to 6 kbar and 475°-500°C, and the Pollock Mountain plate (PMP) shows evidence for polymetamorphism and records burial and heating paths to final equilibration conditions of 9-11 kbar and 600°-625° C. Ar-Ar hornblende ages combined with the P-T data suggest that currently exposed levels of the RRP and PMP were juxtaposed against one another at 15-20 km depth at or prior to 118 Ma, indicating that 10-20 km of uplift, and hence also the onset of collision-related metamorphism, occurred before ˜118 Ma. Correlation of the metamorphic and age data with geometric constraints from the initial Sr 0.706 line and the dimensions of the RRP and PMP permit construction of large-scale retrodeformable sections of the west side of the suture from Late Jurassic through Late Cretaceous time. The abrupt nature of the Sr 0.706 line implies that the arc-continent boundary extends vertically through most of the crust, which requires sharp downwarping of the arc lithosphere in order to account for the PMP metamorphic data. Narrow zoned overgrowths on PMP garnets record this burial event and require initially rapid (≥3 km/m.y.) uplift rates in order to be preserved. We suggest that the onset of rapid uplift resulted from the separation of the negatively buoyant lithospheric root from the downwarped arc, allowing buoyant rise of fragments of thickened crust. Detachment of the root is suggested to change the environment of crustal shortening from one in which
Godchaux, M.M.; Bonnichsen, B.
The Western Idaho Ultramafic Belt extends northward from the town of Weiser to the northern end of Dworshak Reservoir; in its northern portion most of the ultramafic bodies are localized along the suture zone where the Mesozoic oceanic accreted terranes meet the continental craton. Of the twenty bodies investigated, all are small, all are in fault contact with their metavolcanic and metasedimentary host rocks, all have been metamorphosed, and all display deformational fabrics in at least some portion of the outcrop area, suggesting that deformation continued after peak metamorphism. The degree of metamorphism ranges from incipient serpentinization to attainment ofmore » equilibrium in the upper amphibolite facies. Some bodies have been intruded by granitic dikes or pegmatite veins after emplacement, and have locally undergone contact metasomatism. Two particularly complex bodies, Asbestos Peak and Misery Ridge, were chosen for detailed petrographic and chemical study. Asbestos Peak is composed mostly of decussate anthophyllite-talc rock containing isolated patches of harzburgite protolith, and has blackwall border zones. Misery Ridge is composed mostly of coarse-grained sheared tremolite-talc schist without remnant protolith, and lacks true blackwall zones. Both bodies exhibit an unusual and enigmatic hornblende-poikiloblastic garnet-green spinel-skeletal ilmenite assemblage, present in some places as well-defined border zones and in other places as cross-cutting bodies.« less
Mall, D.M.; Reddy, P.R.; Mooney, W.D.
The Central Indian Suture (CIS) is a mega-shear zone extending for hundreds of kilometers across central India. Reprocessing of deep seismic reflection data acquired across the CIS was carried out using workstation-based commercial software. The data distinctly indicate different reflectivity characteristics northwest and southeast of the CIS. Reflections northwest of the CIS predominantly dip southward, while the reflection horizons southeast of the CIS dip northward. We interpret these two adjacent seismic fabric domains, dipping towards each other, to represent a suture between two crustal blocks. The CIS itself is not imaged as a sharp boundary, probably due to the disturbed character of the crust in a 20 to 30-km-wide zone. The time sections also show the presence of strong bands of reflectors covering the entire crustal column in the first 65??km of the northwestern portion of the profile. These reflections predominantly dip northward creating a domal structure with the apex around 30??km northwest of the CIS. There are a very few reflections in the upper 2-2.5??s two-way time (TWT), but the reflectivity is good below 2.5??s TWT. The reflection Moho, taken as the depth to the deepest set of reflections, varies in depth from 41 to 46??km and is imaged sporadically across the profile with the largest amplitude occurring in the northwest. We interpret these data as recording the presence of a mid-Proterozoic collision between two micro-continents, with the Satpura Mobile Belt being thrust over the Bastar craton. ?? 2008.
Knapmeyer-Endrun, Brigitte; Krüger, Frank; Geissler, Wolfram H.; Passeq Working Group
We present a high-resolution study of the upper mantle structure of Central Europe, including the western part of the East European Platform, based on S-receiver functions of 345 stations. A distinct contrast is found between Phanerozoic Europe and the East European Craton across the Trans-European Suture Zone. To the west, a pronounced velocity reduction with depth interpreted as lithosphere-asthenosphere boundary (LAB) is found at an average depth of 90 km. Beneath the craton, no strong and continuous LAB conversion is observed. Instead we find a distinct velocity reduction within the lithosphere, at 80-120 km depth. This mid-lithospheric discontinuity (MLD) is attributed to a compositional boundary between depleted and more fertile lithosphere created by late Proterozoic metasomatism. A potential LAB phase beneath the craton is very weak and varies in depth between 180 and 250 km, consistent with a reduced velocity contrast between the lower lithosphere and the asthenosphere. Within the Trans-European Suture Zone, lithospheric structure is characterized by strong heterogeneity. A dipping or step-wise increase to LAB depth of 150 km is imaged from Phanerozoic Europe to 20-22° E, whereas no direct connection to the cratonic LAB or MLD to the east is apparent. At larger depths, a positive conversion associated with the lower boundary of the asthenosphere is imaged at 210-250 km depth beneath Phanerozoic Europe, continuing down to 300 km depth beneath the craton. Conversions from both 410 km and 660 km discontinuities are found at their nominal depth beneath Phanerozoic Europe, and the discontinuity at 410 km depth can also be traced into the craton. A potential negative conversion on top of the 410 km discontinuity found in migrated images is analyzed by modeling and attributed to interference with other converted phases.
Ring, Uwe; Ratschbacher, Lothar; Frisch, Wolfgang
The Arosa zone forms a melange complex along the Penninic/Austroalpine boundary and belongs to the main Alpine suture zone. Accretion and plate collision occurred during Cretaceous and lower Tertiary time. A mixture of ophiolitic rocks and pelagic sediments is imbricated with flysch and blocks of Austroalpine (continental) derivation. We present a description of deformation structures, an analysis of strain, and a kinematic interpretation based on structural work. Deformation histories of imbricates show a translation path that was west-directed between ca. 110 and 50 Ma and north-directed thereafter. The kinematics of the Arosa zone agrees with the recently deduced displacement history of the Austroalpine units in the Eastern Alps during the Cretaceous orogeny. This calls for a predominantly top-to-the-west imbrication of Austroalpine and Penninic units and is in contradiction to what is inferred in most models of the Eastern Alps. A direct relation between the deformation along the Austroalpine margin and relative plate motion existed.
Powell, C. A.
The eastern Tennessee seismic zone (ETSZ) may represent reactivation of an ancient shear zone that accommodated left-lateral, transpressive motion of the Amazon craton during the Grenville orogeny. Several different lines of evidence support this concept including velocity models for the crust, earthquake hypocenter alignments, focal mechanism solutions, potential field anomalies, paleomagnetic pole positions, and isotopic geochemical studies. The ETSZ trends NE-SW for about 300 km and displays remarkable correlation with the prominent New York - Alabama (NY-AL) aeromagnetic lineament. Vp and Vs models for the crust derived from a local ETSZ earthquake tomography study reveal the presence of a narrow, NE-SW trending, steeply dipping zone of low velocities that extends to a depth of at least 24 km and is associated with the vertical projection of the NY-AL aeromagnetic lineament. The low velocity zone is interpreted as a major basement fault. The recent Mw 4.2 Perry County eastern Kentucky earthquake occurred north of the ETSZ but has a focal depth and mechanism that are similar to those for ETSZ earthquakes. We investigate the possibility that the proposed ancient shear zone extends into eastern Kentucky using Bouguer and aeromagnetic maps. The southern end of the ETSZ is characterized by hypocenters that align along planes dipping at roughly 45 degrees and focal mechanisms that contain large normal faulting components. The NY-AL aeromagnetic lineament also changes trend in the southern end of the ETSZ and the exact location of the lineament is ambiguous. We suggest that the southern portion of the ETSZ involves reactivation of reverse faults (now as normal faults) that mark the ancient transition between a collisional to a more transpressive boundary between Amazonia and Laurentia during the formation of the super continent Rodinia.
Jóźwiak, Waldemar; Ślęzak, Katarzyna; Nowożyński, Krzysztof; Neska, Anne
The area covered by magnetotelluric surveys in Poland is mostly related to the Trans-European Suture Zone (TESZ), the largest tectonic boundary in Europe. Numerous 1D, 2D, and pseudo-3D and 3D models of the electrical resistivity distribution were constructed, and a new interpretation method based on Horizontal Magnetic Tensor analysis has been applied recently. The results indicate that the TESZ is a lithospheric discontinuity and there are noticeable differences in geoelectric structures between the East European Craton (EEC), the transitional zone (TESZ), and the Paleozoic Platform (PP). The electromagnetic sounding is a very efficient tool for recognizing the lithospheric structure especially it helps in identification of important horizontal (or lateral) inhomogeneities in the crust. Due to our study we can clearly determine the areas of the East European Craton of high resistivity, Paleozoic Platform of somewhat lower resistivity value, and transitional TESZ of complicated structure. At the East European Craton, we observe very highly resistive lithosphere, reaching 220-240 km depth. Underneath, there is distinctly greater conductivity values, most probably resulting from partial melting of rocks; this layer may represent the asthenosphere. The resistivity of the lithosphere under the Paleozoic Platform is somewhat lower, and its thickness does not exceed 150 km. The properties of the lithosphere in the transition zone, under the TESZ, differ significantly. The presented models include prominent, NW-SE striking conductive lineaments. These structures, that related with the TESZ, lie at a depth of 10-30 km. They are located in a mid-crustal level and they reach the boundary of the EEC. The structures we initially connect to the Variscan Deformation Front (VDF) and the Caledonian Deformation Front (CDF). The differentiation of conductivity visible in the crust continues in the upper mantle.
Indian participation in this project was terminated during the last year by a sudden withdrawal of support by the Department of Science and Technology, India, to the Indian Institute of Geomagnetism, Bombay. As a result, significant changes in the project focus had to be undertaken. Much of the work carried out at Southern Illinois University at Carbondale during the first year of the project anticipated the Indian participation and included development of computer programs to be used on gravity and magnetic data from the Indian subcontinent and preparations for fieldwork, tutorials, and workshops in India. Despite these setbacks, which were beyond our control, a number of significant tasks have been accomplished during the project period. These include: (1) Completion of digitization of the regional Bouguer gravity anomaly map of India and the regional ground total intensity magnetic anomaly map of India at an overdetermined spacing of 0.05 degrees. (2) We investigated and assessed the limitations of the Euler method using environmental examples because detailed aeromagnetic maps of parts of India were not available for interpretation by this method. (3) We also undertook an assessment of a suture zone between the Nyaza Craton (Archean) and the Mozambique Belt (Pan African) in the Kenya Rift, Africa, using gravity anomalies and the lithospheric seismological models. (4) We studied Magsat and high-altitude (approx. 4 km) aeromagnetic data over Canada.
Payet, Samuel D.; Hobbs, Jean-Paul A.; DiBattista, Joseph D.; Newman, Stephen J.; Sinclair-Taylor, Tane; Berumen, Michael L.; McIlwain, Jennifer L.
Hybridisation is a significant evolutionary process that until recently was considered rare in the marine environment. A suture zone in the eastern Indian Ocean is home to numerous hybridising sister species, providing an ideal opportunity to determine how hybridisation affects speciation and biodiversity in coral reef fishes. At this location, hybridisation between two grouper (Epinephelidae) species: Cephalopholis urodeta (Pacific Ocean) and C. nigripinnis (Indian Ocean) was investigated to determine the genetic basis of hybridisation and to compare the ecology and life history of hybrids and their parent species. This approach aimed to provide insights into the taxonomic and evolutionary consequences of hybridisation. Despite clear phenotypic differences, multiple molecular markers revealed hybrids, and their parent species were genetically homogenous within and (thousands of kilometres) outside of the hybrid zone. Hybrids were at least as fit as their parent species (in terms of growth, reproduction, and abundance) and were observed in a broad range of intermediate phenotypes. The two species appear to be interbreeding at Christmas Island due to inherent biological and ecological compatibilities, and the lack of genetic structure may be explained by three potential scenarios: (1) hybridisation and introgression; (2) discordance between morphology and genetics; and (3) incomplete lineage sorting. Further molecular analyses are necessary to discriminate these scenarios. Regardless of which applies, C. urodeta and C. nigripinnis are unlikely to evolve in reproductive isolation as they cohabit where they are common (Christmas Island) and will source congeneric mates where they are rare (Cocos Keeling Islands). Our results add to the growing body of evidence that hybridisation among coral reef fishes is a dynamic evolutionary factor.
Wilde-Piorko, M.; Chrapkiewicz, K.; Lepore, S.; Polkowski, M.; Grad, M.
The Trans-European Suture Zone (TESZ) is one of the most prominent suture zones in Europe separating the young Paleozoic Platform from the much older Precambrian East European Craton. The data recorded by "13 BB Star" broadband seismic stations (Grad et al., 2015) are analyzed to investigate the crustal and upper mantle structure of the margin of the Trans-European Suture Zone (TESZ) in northern Poland. Receiver function (RF) locally provides the signature of sharp seismic discontinuities and information about the shear wave (S-wave) velocity distribution beneath the seismic station. Recorded seismograms are rotated from ZNE to LQT system with method using the properties of RF (Wilde-Piórko, 2015). Different techniques of receiver function interpretation are applied, including 1-D inversion of RF, 1-D forward modeling of RF, 2.5D forward modeling of RF, 1-D join inversion of RF and dispersion curves of surface wave, to find the best S-wave velocity model of the TESZ margin. A high-resolution 3D P-wave velocity model in the area of Poland (Grad et al. 2016) are used as a starting model. National Science Centre Poland provided financial support for this work by NCN grant DEC-2011/02/A/ST10/00284.
Bonnet, G.; Agard, P.; Angiboust, S.; Fournier, M.; Omrani, J.
Large-scale seafloor topographic features, such as seamounts, are for the most part subducted with the downgoing oceanic plate. They are expected to critically impact the seismogenic and mechanic behavior of subduction zones, but their exact role is strongly debated (i.e., as to whether they represent barriers to propagation or asperities promoting nucleation). Rare natural examples of metamorphosed seamounts, which got sliced off the slab along the plate interface and escaped recycling into the mantle, are therefore precious witnesses to document processes operating at depths of 0-30 km. We herein report the existence of a large-scale oceanic topographic structure sandwiched in the Zagros suture zone (Siah Kuh - SK - unit), most probably a former seamount, along with other blueschist units (Angiboust et al., EPSL 2016). The main criteria for identifying this seamount are its: (1) shape: the SK unit is a 1.5-2 km thick, rounded-shaped body with a 15-20 km diameter, (2) lithologies: it is made mainly of a regular succession of massive basaltic flows, commonly as pillow basalts, minor ophiolite-type gabbros and serpentinite, together with subordinate more differenciated volcanic and plutonic rocks. (3) sedimentary cover: basalts are overlain by shallowly deposited reef limestone and deepening-up sediments with the occurrence of cherts and pelagic limestones (which points to possible subsidence). Basalts have been analyzed for trace elements and have usually a N-MORB to OIB signature, which might be explained by its potential origin as a mid-oceanic ridge seamount. HP-LT minerals (lawsonite, aragonite, blue amphiboles) found across the whole structure, particularly in zones of localized compressive deformation, indicate that this seamount was shallowly subducted at 20 km. This deformation, interpreted to be syn-subduction, is assisted by a décollement rooting in serpentinite and/or oceanic metasediments and is associated with rare cataclase in magmatic rocks. We
Moosavi, E.; Rasouli-Jamadi, F.
The Paleo-Tethys suture zone in northern Iran was formed when the Paleo-Tethys Ocean, (between Gonwana-derived Alborz Microcontinent and the Turan Plate), closed during the Eocimmerian orogeny and after they collided together in the Mid-Late Triassic. The NW-striking Boghrov-Dagh basement Fault Zone that lies in the vicinity of Masuleh village and the southern boundary of Gasht Metamorphic Complex is a part of the Eocimmerian suture zone in the Western Alborz. Along this part of the suture zone, tourmaline leucogranites intruded in metamorphic rocks. We recognize three distinct deformation stages (D1 to D3) in the study area especially in the Masuleh Shear Zone. D1 which was synchronous with formation of the main metamorphic minerals, such as sillimanite and staurolite under medium- to high-grade metamorphic conditions probably during the Hercynian event and a NE-directed shortening. The slaty cleavage in metamorphosed Upper Paleozoic rocks and crenulation cleavage and folds in the older rocks were produced due to D2 deformation during the Eocimmerian event under greenschist facies conditions. The Masuleh Shear Zone formed as a result of a ductile strike-slip shear during the Early-Middle Jurassic Mid-Cimmerian D3 event with a pure dextral to transtension shear sense at low to locally medium-grade conditions. All of the D3 structural features agree with a NNW-directed compression and an ENE-directed extension caused by overall dextral shear parallel to the Masuleh shear zone and the Boghrov-Dagh Fault Zone. Based on the available evidence, especially cross-cutting relationships between structural fabrics and rock units, emplacement of the Gasht-Masuleh leucogranites occurred after the D2 collisional event coeval to the possible slab break-off and before the D3 event, between Eocimmerian and Mid-Cimmerian movements.
Milano, Maurizio; Fedi, Maurizio
One of the main goals in crustal geomagnetic prospecting is to obtain information about the sources of magnetic anomalies in order to model the geological structure of the Earth's crust. A "multiscale approach" is very useful to analyze, concurrently, the effects of sources placed at different depths, observing the potential field at various altitudes from the Earth's surface. The aim of this work is the study of the main geological structure of Central Europe, the "Trans European Suture Zone", using high-resolution aeromagnetic data. The 'TESZ' is the most prominent geological boundary in Europe, oriented NW-SE from the North Sea to the Black Sea and separating The Paleozoic platform in the south and west from the Precambrian East European craton. At high altitudes the European magnetic field is characterized by a large and extended magnetic low, which is related to the deep TESZ structure. The study of this anomaly field began by detecting the position of the anomaly sources using the properties of the Analytical Signal modulus (AS). The AS map presents anomalies in which the dipolar behavior of the magnetic anomaly field is substantially removed and the maxima are placed directly above the anomaly sources. The multiridge method has been applied to the Analytical Signal modulus in order to have information about the sources' depths in the TESZ region. Many profiles were tracked transversely to the fault line in order to map at depth the main magnetic discontinuities. Cause of the low heat flow of the Central Europe, we were able to get information also in the lower crust and to map the deep Moho discontinuity. Available geological sections based on seismic data show consistent results with our interpretation.
Becker, Gesa; Knapmeyer-Endrun, Brigitte
GERESS-array, it is shown that the processing scheme is also applicable to short period stations. Subsequently it is applied to the mainly short period and temporary stations of the PASSEQ network along the seismic profile POLONAISE P4, running from Eastern Germany to Lithuania crossing the Trans-European Suture Zone.
Nuyen, C.; Porritt, R. W.; O'Driscoll, L.
The Wyoming Province is an Archean craton that played an early role in the construction and growth of the North American continent. This region, which encompasses the majority of modern day Wyoming and southern Montana, initially collided with other Archean blocks in the Paleoproterozoic (2.0-1.8 Ga), creating the Canadian Shield. From 1.8-1.68 Ga, the Yavapai Province crashed into the Wyoming Province, suturing the two together. The accretion of the Yavapai Province gave way to the Cheyenne Belt, a deformational zone that exists along the southern border of the Wyoming Province where earlier studies have found evidence for crustal imbrication and double a Moho. Current deformation within the Wyoming province is due to its interaction with the Yellowstone Hotspot, which is currently located in the northwest portion of the region. This study images the LAB along the western and southern borders of the Wyoming Province in order to understand how the region's Archean lithosphere has responded to deformation over time. These results shed light on the inherent strength of Archean cratonic lithosphere in general. We employ two methods for this study: common conversion point (CCP) stacking of S to P receiver functions and teleseismic and ambient Rayleigh wave dispersion. The former is used to image the LAB structure while the latter is used to create a velocity gradient for the region. Results from both of the methods reveal a notably shallower LAB depth to the west of the boundary. The shallower LAB west of the Wyoming Province is interpreted to be a result of lithospheric thinning due to the region's interaction with the Yellowstone Hotspot and post-Laramide deformation and extension of the western United States. We interpret the deeper LAB east of the boundary to be evidence for the Wyoming Province's resistance to lithospheric deformation from the hotspot and tectonic processes. CCP images across the Cheyenne Belt also reveal a shallower LAB under the western
Knapmeyer-Endrun, Brigitte; Krüger, Frank; Passeq Working Group
volcanism, thinning of the crust corresponds to lithospheric updoming reported in recent surface wave and S-receiver function studies, as expected for thermally induced deformation. The same correlation applies for crustal thickening, not only across the Trans-European Suture Zone, but also within the southern part of the Bohemian Massif. A high Poisson's ratio of 0.27 is obtained for the craton, which is consistent with a thick mafic lower crust. In contrast, we typically find Poisson's ratios around 0.25 for Phanerozoic Europe outside of deep sedimentary basins. Mapping of the thickness of the shallowest crustal layer, that is low-velocity sediments or weathered rock, indicates values in excess of 6 km for the most pronounced basins in the study area, while thicknesses of less than 4 km are found within the craton, central Germany and most of the Czech Republic.
Liang, Xiao; Sun, Shengshi; Dong, Yunpeng; Yang, Zhao; Liu, Xiaoming; He, Dengfeng
The ductile shearing along the Shangdan suture zone during the Paleozoic time is a key to understand the collisional deformation and tectonic regime of amalgamation between the North China Block and the South China Blocks. The Wushan ductile shear zone, a branch of the Shangdan suture, records mylonitic deformation that affected granitic and felsic rocks outcropping in an over 1 km wide belt in the western Qinling Orogenic belt. Shear sense indicators and kinematic vorticity number (0.79-0.99) of the mylonites reveal a dextral shear deformation. The quartz c-axis fabrics indicate activation of combined basal and rhomb slip, prism slip and prism
Liang, Xiao; Sun, Shengsi; Dong, Yunpeng; Yang, Zhao; Liu, Xiaoming; He, Dengfeng
The ductile shearing along the Shangdan suture zone during the Paleozoic time is a key to understand the collisional deformation and tectonic regime of amalgamation between the North China Block and the South China Blocks. The Wushan ductile shear zone, a branch of the Shangdan suture, records mylonitic deformation that affected granitic and felsic rocks outcropping in an over 1 km wide belt in the western Qinling Orogenic belt. Shear sense indicators and kinematic vorticity number (0.79-0.99) of the mylonites reveal a dextral shear deformation. The quartz c-axis fabrics indicate activation of combined basal and rhomb slip, prism slip and prism
Ali, Sarmad A.; Sleabi, Rajaa S.; Talabani, Mohammad J. A.; Jones, Brian G.
Marine clastic rocks occurring in the Walash and Naopurdan Groups in the Hasanbag and Qalander areas, Kurdistan region, Iraqi Zagros Suture Zone, are lithic arenites with high proportions of volcanic rock fragments. Geochemical classification of the Eocene Walash and Oligocene Naopurdan clastic rocks indicates that they were mainly derived from associated sub-alkaline basalt and andesitic basalt in back-arc and island arc tectonic settings. Major and trace element geochemical data reveal that the Naopurdan samples are chemically less mature than the Walash samples and both were subjected to moderate weathering. The seaway in the southern Neotethys Ocean was shallow during both Eocene and Oligocene permitting mixing of sediment from the volcanic arcs with sediment derived from the Arabian continental margin. The Walash and Naopurdan clastic rocks enhance an earlier tectonic model of the Zagros Suture Zone with their deposition occurring during the Eocene Walash calc-alkaline back-arc magmatism and Early Oligocene Naopurdan island arc magmatism in the final stages of intra-oceanic subduction before the Miocene closure and obduction of the Neotethys basin.
Chetty, T. R. K.; Yellappa, T.; Nagesh, P.; Mohanty, D. P.; Venkatasivappa, V.; Santosh, M.; Tsunogae, T.
Detailed geological and structural mapping of the Manamedu ophiolite complex (MOC), from the south-eastern part of the Cauvery suture zone (CSZ) within the Gondwana collisional suture in southern India reveals the anatomy of a dismembered ophiolite succession comprising pyroxenite actinolite-hornblendite, hornblendite, gabbro-norite, gabbro, anorthosite, amphibolite, plagiogranite, mafic dykes, and associated pelagic sediments such as chert-magnetite bands and carbonate horizons. The magmatic foliation trajectory map shows inward dipping foliations and a variety of fold structures. Structural cross-sections of the MOC reveal gentle inward dips with repetition and omission of different lithologies often marked by curvilinear hinge lines. The succession displays imbricate thrust sheets and slices of dismembered ophiolite suites distributed along several localities within the CSZ. The MOC can be interpreted as a deformed large duplex structure associated with south-verging back thrust system, consistent with crustal-scale 'flower structure'. The nature and distribution of ophiolitic rocks in the CSZ suggest supra-subduction zone setting associated with the lithospheric subduction of the Neoproterozoic Mozambique Ocean, followed by collision and obduction during the final stage of amalgamation of the Gondwana supercontinent in the end Precambrian.
Fritschle, Tobias; Daly, J. Stephen; Whitehouse, Martin J.; McConnell, Brian; Buhre, Stephan
Upper Palaeozoic sedimentary basins in Ireland overlie crystalline rocks within the Caledonian Iapetus Suture Zone. Beneath these basins, Lower Palaeozoic rocks, formed and deformed during the Caledonian orogenic cycle, were intruded by c. 420-390 Ma late-tectonic granites at various tectonic levels. These include the subsurface Kentstown and Glenamaddy granites discovered by mineral exploration drilling. While these granites comprise actual targets for Enhanced Geothermal System (EGS) exploration, several others likely exist based on geophysical considerations. In order to test the regional geothermal potential, the buried granites as well as analogue exposed rocks are being investigated geochemically. The geothermal potential of the intrusives depends on their heat production rate (HPR), which is calculated using rock density and concentrations of the heat producing elements (HPE) uranium, thorium and potassium. In spite of their close spacing and similar ages, the whole-rock geochemistry of the granites varies significantly, but with no obvious geographical control (Fritschle et al., 2013; 2014). The granite HPR values range from 1.4 μW/m3 for the Dhoon Granite (Isle of Man) to 4.9 μW/m3 for the Drogheda Granite (Ireland). This compares with the average HPR for a 'typical' granite of 2.7 μW/m3 (Goldstein et al., 2009). It is demonstrated that an elevated HPR of a granite can be related to enrichment in one of the HPE alone (e.g., uranium-enrichment in the Foxdale Granite (Isle of Man), or thorium-enrichment in the Drogheda Granite). Enrichment in HPE in a granite may occur due to different reasons including hydrothermal (re-) distribution of uranium, or the assimilation of thorium-rich wall-rocks. Hence, the distribution of the HPE in particular minerals, veins and source lithologies, along with the petrophysical characteristics of the sedimentary basins and the granites' petrogenesis, are currently being investigated as possible mechanisms controlling their
Polkowski, M.; Grad, M.; Ostaficzuk, S.
Poland is located on conjunction of major European tectonic units - the Precambrian East European Craton and the Paleozoic Platform of Central and Western Europe. This conjunction is known as Trans-European Suture Zone (TESZ). Geological and seismic structure under area of Poland is well studied by over one hundred thousand boreholes, over thirty deep seismic refraction and wide angle reflection profiles and other methods: vertical seismic profiling, magnetic, gravity, magnetotelluric, thermal. Compilation of these studies allows creation of detailed, high-resolution 3D P-wave velocity model for entire Earth's crust in the area of Poland. Model provides detailed six layer sediments (Tertiary and Quaternary, Cretaceous, Jurassic, Triassic, Permian, old Paleozoic), consolidated / crystalline crust and uppermost mantle. Continental suturing is a fundamental part of the plate tectonic cycle, and knowing its detailed structure allows understanding plate tectonic cycle. We present a set of crustal cross sections through the TESZ, illustrating differentiation in the structure between Precambrian and Wariscan Europe. National Science Centre Poland provided financial support for this work by NCN grant DEC- 2011/02/A/ST10/00284.
Ye, Gaofeng; Jin, Sheng; Wei, Wenbo; Jing, Jian'en
The closure of the Paleo-Asian Ocean along the Solonker Suture Zone (SSZ) during the Late Permian and Triassic represented the final stage in the formation of the Central Asian Orogenic Belt between the Siberian Craton and the North China Craton. In order to better understand the structure and formation of this ancient subduction zone, a high-resolution magnetotelluric (MT) profile was collected with both broadband and long-period MT data. The high resolution mapping of the lithosphere achieved in this study is due to the closely spaced MT stations (2-3 km). With the 2-D resistivity model, a south-dipping conductor was detected and extends through the entire crust. The geometry of this feature provides evidence that a southward directed subduction zone formed the Solonker suture. The enhanced conductivity was interpreted to subducted sulfide-bearing graphitic sediments. The resistive body beneath the northern margin of the North China Craton indicates a thickened lithosphere caused by the southward subduction at this region, and the resistive body beneath the Solonker Suture Zone indicates the subducted oceanic lithosphere. North-dipping low resistivity features were also detected in the crust of both the North China Craton and Central Asian Orogenic Belt, and were interpreted as post-collisional thrust faults. Strong anisotropy was found beneath the suture zone, and can be explained if the high strain rate has rotated the fold axes into the dip direction.
Martin, C.; Harlow, G. E.; Flores, K. E.; Angiboust, S.
Serpentinites are known to play a key role in subduction, because they contain significant water content and can be enriched in elements such as As, B, Li, Sb, and U. They originate by hydration of peridotite by two different processes: (i) by a seawater source reacting with peridotite beneath the ocean crust and (ii) by reaction of peridotite at the base of the mantle-wedge with fluids released from the slab during subduction. In suture zones, it is relatively common to find serpentinite from both exhumed subduction channel mélange (from the mantle wedge) and ophiolite (from the oceanic crust), but recognizing them and their tectonic origin can be difficult. A recent study based on samples from the Guatemala Suture Zone demonstrated that boron (B) isotopes can be used as a probe of the fluid from which serpentinites form. Serpentinites from an ophiolite complex have positive δ11B, as expected for peridotites hydrated by seawater-derived fluid, whereas serpentinite samples from the matrix of the mélange (coming from the roof of the subducting channel) have negative δ11B, in agreement with hydration of mantellic peridotites by fluids released at 30-70 km depth from metamorphic rocks. Serpentinites from tectonically well-constrained locations were selected to extend our knowledge of metasomatism in subduction-related areas. The trace-element contents and B isotopes were measured in situ, respectively by LA-ICP-MS and LA-MC-ICP-MS on samples from the oceanic crust (ophiolite = Guatemala, Iran, Cuba), the subduction forearc (Nicaragua), and the mantle wedge (Guatemala, Iran, Japan, Myanmar). The spider diagrams and REE patterns, as well as a B/La vs. As/La diagram do not show any reliable difference to distinguish the tectonic origin of the serpentinite. However, in a δ11B vs. B content diagram, the serpentinites seem to plot in a triangle with fluid endmembers representing (i) seawater (δ11B = 40‰, [B] = 5ppm), (ii) metabasite-issued metamorphic fluids, and
Hassim, M. F. B.; Carrapa, B.; DeCelles, P. G.; Kapp, P. A.; Gehrels, G. E.
Our detrital geochemical study of modern sand collected from tributaries of the Yarlung River in southern Tibet and the Kali Gandaki River and its tributaries in Nepal shed light on the ages and exhumation histories of source rocks within the Indus-Yarlung Suture (IYS) zone and the Himalayas. Seven sand samples from rivers along the suture zone in southern Tibet between Xigatze to the east and Mt. Kailas to the west were collected for detrital zircon U-Pb geochronologic and Apatite Fission Track (AFT) thermochronologic analyses. Zircon U-Pb ages for all rivers range between 15 and 3568 Ma. Rivers draining the northern side of the suture zone mainly yield ages between 40 and 60 Ma, similar to the age of the Gangdese magmatic arc. Samples from rivers draining the southern side of the suture zone record a Tethyan Himalayan signal characterized by age clusters at 500 Ma and 1050 Ma. Our results indicate that the ages and proportion of U-Pb zircons ages of downstream samples from tributaries of the Yarlung River directly reflect source area ages and relative area of source rock exposure in the catchment basin. Significant age components at 37 - 40 Ma, 47 - 50 Ma, 55 - 58 Ma and 94 - 97 Ma reflect episodicity in Gangdese arc magmatism. Our AFT ages show two main signals at 23-18 Ma and 12 Ma, which are in agreement with accelerated exhumation of the Gangdese batholith during these time intervals. The 23 - 18 Ma signal partly overlaps with deposition of the Kailas Formation along the suture zone and may be related to exhumation due to upper plate extension in southern Tibet in response to Indian slab rollback and/or break-off events. Detrital thermochronology of four sand samples from the Kali Gandaki River and some of its tributaries in Nepal is underway and will provide constraints on the timing of erosion of the central Nepal Himalaya.
Özacar, Arda A.; Abgarmi, Bizhan
The North Anatolian Fault Zone (NAFZ) is an active continental transform plate boundary that accommodates the westward extrusion of the Anatolian plate. The central segment of NAFZ displays northward convex surface trace which coincides partly with the Paleo-Tethyan suture formed during the early Cenozoic. The depth extent and detailed structure of the actively deforming crust along the NAF is still under much debate and processes responsible from rapid uplift are enigmatic. In this study, over five thousand high quality P receiver functions are computed using teleseismic earthquakes recorded by permanent stations of national agencies and temporary North Anatolian Fault Passive Seismic experiment (2005-2008). In order to map the crustal thickness and Vp/Vs variations accurately, the study area is divided into grids with 20 km spacing and along each grid line Moho phase and its multiples are picked through constructed common conversion point (CCP) profiles. According to our results, nature of discontinuities and crustal thickness display sharp changes across the main strand of NAFZ supporting a lithospheric scale faulting that offsets Moho discontinuity. In the southern block, crust is relatively thin in the west ( 35 km) and becomes thicker gradually towards east ( 40 km). In contrast, the northern block displays a strong lateral change in crustal thickness reaching up to 10 km across a narrow roughly N-S oriented zone which is interpreted as the subsurface signature of the ambiguous boundary between Istanbul Block and Pontides located further west at the surface.
Large-scale geoelectrical anomalies have been mapped with geomagnetic depth sounding (GDS) and magnetotelluric (MT) surveys in the Carpathian Mountains region. These anomalies are associated with the zone of closure between stable Europe and a complex of microplates in front of the converging African plate. The zone of closure, or suture zone, is largely occupied by an extensive deformed flysch belt. The models derived to fit the observed geoelectrical data are useful in the study of other suture zones, and Carpathian structures have been compared with areas currently being studied in the western Cordillera of the U.S.A. Models derived for a smaller-scale suture zone mapped in western Washington State have features that are similar to the Carpathian models. The geoelectrical models for both the Carpathian and Washington anomalies require dipping conductive slabs of 1-5 ?? m material that extends to depths > 20 km. In both instances there is evidence that these materials may merge with lower crustal-mantle conductors along the down-dip margins of the slab. The main conductive units are interpreted to be sedimentary rocks that have been partially subducted due to collisional processes. Heat flow is low in both regions and it is difficult to explain fully the deep conduction mechanisms; however, evidence suggests that the conduction at depth may include electronic conduction in sulfide mineral or carbon films as well as ionic conduction in fluids or partial melt. ?? 1989.
Azizi, Hossein; Hadi, Ayten; Asahara, Yoshihiro; Mohammad, Youssef Osman
The Iraqi Zagros Orogenic Belt includes two separate ophiolite belts, which extend along a northwest-southeast trend near the Iranian border. The outer belt shows ophiolite sequences and originated in the oceanic ridge or supra-subduction zone. The inner belt includes the Mawat complex, which is parallel to the outer belt and is separated by the Biston Avoraman block. The Mawat complex with zoning structures includes sedimentary rocks with mafic interbedded lava and tuff, and thick mafic and ultramafic rocks. This complex does not show a typical ophiolite sequences such as those in Penjween and Bulfat. The Mawat complex shows evidence of dynamic deformation during the Late Cretaceous. Geochemical data suggest that basic rocks have high MgO and are significantly depleted in LREE relative to HREE. In addition they show positive ɛ Nd values (+5 to+8) and low 87Sr/86Sr ratios. The occurrence of some OIB type rocks, high Mg basaltic rocks and some intermediate compositions between these two indicate the evolution of the Mawat complex from primary and depleted source mantle. The absence of a typical ophiolite sequence and the presence of good compatibility of the source magma with magma extracted from the mantle plume suggests that a mantle plume from the D″ layer is more consistent as the source of this complex than the oceanic ridge or supra-subduction zone settings. Based on our proposed model the Mawat basin represents an extensional basin formed during the Late Paleozoic to younger along the Arabian passive margin oriented parallel to the Neo-Tethys oceanic ridge or spreading center. The Mawat extensional basin formed without creation of new oceanic basement. During the extension, huge volumes of mafic lava were intruded into this basin. This basin was squeezed between the Arabian Plate and Biston Avoraman block during the Late Cretaceous.
Sampson, Jay A.; Rodriguez, Brian D.
North-central Nevada contains a large amount of gold in linear belts, the origin of which is not fully understood. During July 2008, September 2009, and August 2010, the U.S. Geological Survey, as part of the Assessment Techniques for Concealed Mineral Resources project, collected twenty-three magnetotelluric soundings along two profiles in Box Elder County, Utah; Elko County, Nevada; and Cassia, Minidoka, and Blaine Counties, Idaho. The main twenty-sounding north-south magnetotelluric profile begins south of Wendover, Nev., but north of the Deep Creek Range. It continues north of Wendover and crosses into Utah, with the north profile terminus in the Snake River Plain, Idaho. A short, three-sounding east-west segment crosses the main north-south profile near the northern terminus of the profile. The magnetotelluric data collected in this study will be used to better constrain the location and strike of the concealed suture zone between the Archean crust and the Paleoproterozoic Mojave province. This report releases the magnetotelluric sounding data that was collected. No interpretation of the data is included.
Yellappa, T.; Tsunogae, T.; Chetty, T. R. K.; Santosh, M.
The dismembered units of the Neoproterozoic Manamedu Ophiolite Complex (MOC) in the Cauvery Suture Zone, southern India comprises a well preserved ophiolitic sequence of ultramafic cumulates of altered dunites, pyroxenites, mafic cumulates of gabbros, gabbro-norites and anorthosites in association with plagiogranites, isotropic gabbros, metadolerites, metabasalts/amphibolites and thin layers of ferruginous chert bands. The isotropic gabbros occur as intrusions in association with gabbroic anorthosites, plagiogranite and metabasalts/amphibolites. The gabbros are medium to fine grained with euhedral to subhedral orthopyroxenes, clinopyroxenes and subhedral plagioclase, together with rare amphiboles. Mineral chemistry of isotropic gabbros reveal that the clinopyroxenes are diopsidic to augitic in composition within the compositional ranges of En(42-59), Fs(5-12), Wo(31-50). They are Ca-rich and Na poor (Na2O < 0.77 wt%) characterized by high-Mg (Mg# 79-86) and low-Ti (TiO2 < 0.35 wt%) contents. The tectonic discrimination plots of clinopyroxene data indicate island arc signature of the source magma. Our study further confirms the suprasubduction zone origin of the Manamedu ophiolitic suite, associated with the subduction-collision history of the Neoproterozoic Mozambique ocean during the assembly of Gondwana supercontinent.
Yellappa, T.; Venkatasivappa, V.; Koizumi, T.; Chetty, T. R. K.; Santosh, M.; Tsunogae, T.
Several Precambrian mafic-ultramafic complexes occur along the Cauvery Suture Zone (CSZ) in Southern Granulite Terrain, India. Their origin, magmatic evolution and relationship with the associated high-grade rocks have not been resolved. The Aniyapuram Mafic-Ultramafic Complex (AMUC), the focus of the present study in southern part of the CSZ, is dominantly composed of peridotites, pyroxenites, gabbros, metagabbros/mafic granulites, hornblendites, amphibolites, plagiogranites, felsic granulites and ferruginous cherts. The rock types in the AMUC are structurally emplaced within hornblende gneiss (TTG) basement rocks and are highly deformed. The geochemical signature of the amphibolites indicates tholeiitic affinity for the protolith with magma generation in island arc-setting. N-MORB normalized pattern of the amphibolites show depletion in HFS-elements (P, Zr, Sm, Ti, and Y) and enrichment of LIL-elements (Rb, Ba, Th, Sr) with negative Nb anomalies suggesting involvement of subduction component in the depleted mantle source and formation in a supra-subduction zone tectonic setting. Our new results when correlated with the available age data suggest that the lithological association of AMUC represent the remnants of the Neoarchean oceanic lithosphere.
Bonev, Nikolay; Filipov, Petyo
In the Hellenides of northern Greece, the Sithonia back-arc ophiolite constitute an element of the Vardar suture zone against the Chortiatis island arc magmatic suite, the Melissochori Formation and the Serbo-Macedonian Massif further north at the Mesozoic continental margin of Eurasia. A granodiorite from the Chortiatis island arc magmatic suite crystallized at 160 Ma as derived from new U-Pb zircon geochronology and confirms the end of arc magmatic activity that started at around 173 Ma. Located southerly of the Chortiatis island arc magmatic suite, the Sithonia ophiolite had igneous life from 159 to 149 Ma, and the ophiolite interfinger with clastic-carbonate Kimmeridgian sediments. Magmatic structures (i.e., sheeted dykes) in the ophiolite witness for NE-trending rift axis, while the transform faults and fracture zones sketch NW-SE transcurrent transtension-like propagation of the rift-spreading center at Sithonia that is consistent with a dextral wrench corridor already proposed for the ophiolite origin in the eastern Vardar zone. The tectonic emplacement of the Sithonia ophiolite involved dextral ENE to SE strike-slip sense of shear and SW and NE reverse thrust sense of shear on mostly steep foliation S1, subhorizontal lineation L1 and associated variably inclined F1 fold axes. This structural grain and kinematics are shared by adjacent Chortiatis island arc magmatic suite and the Melissochori Formation. The coexistence of strike-parallel and thrust components of displacement along discrete dextral strike-slip shear zones and internal deformation of the mentioned units is interpreted to result from a bulk dextral transpressive deformation regime developed in greenschist-facies metamorphic conditions. The back-arc ocean floor previous structural architecture with faults and fracture zones where Kimmeridgian sediments deposited in troughs was used by discrete strike-slip shear zones in which these sediments involved, and the shear zones become the sites for
Bierlein, Frank P.; Betts, Peter G.
In marked contrast to Palaeoproterozoic Laurentia, the location of sutures and boundaries of discrete crustal fragments amalgamated during Palaeoproterozoic formation of the North Australian Craton remain highly speculative. Interpretations of suture locations have relied heavily on the analysis of regional geophysical datasets because of sparse exposure of rocks of the appropriate age. The Mount Isa Fault Zone has been interpreted as one such Palaeoproterozoic terrane-bounding suture. Furthermore, the coincidence of this fault zone with major shale-hosted massive sulphide Pb-Zn-Ag orebodies has led to speculations that trans-lithospheric faults may be an important ingredient for the development of this deposit type. This study has integrated geophysical and geochemical data to test the statute of the Mount Isa Fault as a terrane-bounding suture. Forward modelling of gravity data shows that basement rocks on either side of the Mount Isa Fault have similar densities. These interpretations are consistent with geochemical observations and Sm-Nd data that suggest that basement lithologies on either side of the Mount Isa Fault are geochemically and isotopically indistinguishable from each other, and that the Mount Isa Fault is unlikely to represent a suture zone that separates different Palaeoproterozoic terranes. Our data indicate that the crustal blocks on both sides of the Mount Isa Fault Zone must have been in within close proximity of each other since the Palaeoproterozoic, and that the Western Fold Belt was part of the (ancestral) North Australian Craton well before the ˜1.89-1.87 Ga Barramundi Orogeny. It appears that deep crustal variations in density may be related to the boundary between a shallowly west-dipping high-density mafic to ultramafic plate and low-density basement rocks. This interpretation in turn impacts on crustal-scale models for the development of shale-hosted massive sulphide Pb-Zn mineralisation, which do not require trans
Brown, L. D.
Given the 3D framework represented by EarthScope's USArray as it scans eastward, the strategic challenge falls to defining cost-effective deployments of FlexArray to address specific lithospheric targets. Previous deep geophysical surveys (e.g. COCORP, USGS, GLIMPCE, et al.) provide guidance not only in framing the geological issues involved, but in designing field experiments that overcome the limitations of previous work. Opportunities highlighted by these precursor studies include: a) Collisional sutures (e.g. Brunswick Anomaly/Suwannee terrane) which lie buried beneath overthrust terranes/ younger sedimentary covers. Signal penetration in previous controlled source surveys has been insufficient. High resolution passive surveys designed to map intralithospheric detachments, Moho, and mantle subduction scars is needed to validate the extrapolations of the existing upper crustal information; b) Intracratonic basins and domes (e.g. Michigan Basin, Adirondack Dome) are perhaps the greatest geological mystery hosted in the east. Previous geophysical studies have lacked the resolution or penetration needed to identify the buoyancy drivers presumed to be responsible for such structures. It is likely that these drivers lie in the upper mantle and will require detailed velocity imaging to recognized. c) Distributed shear fabrics are a defining characteristic of the deep crust in many deformation zones (e.g. Grenville Front). Detailed mapping of crustal anisotropy associated with such shear zones should help delineate ductile flow directions associated with the orogenies that accreted the eastern U.S. 3 component, 3D active+passive surveys are needed to obtain definitive remote measures of such vector characteristics in the deep crust. d) Extensive reflectors in the central U.S. may mark important buried Precambrian basins and/or sill complexes. If the latter, the magmatic roots of those systems remain unrecognized, as does their volumetric contribution to crustal growth
Bonnet, G.; Flores, K. E.; Martin, C.; Harlow, G. E.
The Guatemala Suture Zone is the fault-bound region in central Guatemala that contains the present North American-Caribbean plate boundary. This major composite geotectonic unit contains a variety of ophiolites, serpentinite mélanges, and metavolcano-sedimentary sequences along with high-grade schists, gneisses, low-grade metasediments and metagranites thrusted north and south of the active Motagua fault system (MFS). The North Motagua Mélange (NMM) outcrops north of the MFS and testifies the emplacement of exhumed subduction assemblages along a collisional tectonic setting. The NMM is composed of a serpentinite-matrix mélange that contains blocks of metabasites (subgreenschist facies metabasalt, grt-blueschist, eclogite, grt-amphibolite), vein-related rocks (jadeitite, omphacitite, albitite, mica-rock), and metatrondhjemites. Our new detailed petrographic and thermobarometric study on the garnet-bearing metabasites reveals a complex polymetamorphic history with multiple tectonic events. Eclogites show a classical clockwise PT path composed of (a) prograde blueschist/eclogite facies within garnet cores, (b) eclogite facies metamorphic peak at ~1.7 GPa and 620°C, (c) post-peak blueschist facies, (d) amphibolite facies overprint, and (e) late stage greenschist facies. Two types of garnet amphibolite blocks can be found, the first consist of (a) a relict eclogite facies peak at ~1.3 GPa and 550°C only preserved within anhedral garnet cores, and (b) surrounded by a post-peak amphibolite facies. In contrast, the second type displays a prograde amphibolite facies at 0.6-1.1 GPa and 400-650°C. The eclogites metamorphic peak suggests formation in a normal subduction zone at ~60 km depth, a subsequent exhumation to the middle section of the subduction channel (~35 km), and a later metamorphic reworking at lower P and higher T before its final exhumation. The first type of garnet amphibolite shows a similar trajectory as the eclogites but at warmer conditions. In
Göçmengil, Gönenç; Karacık, Zekiye; Genç, Ş. Can
Obliteration of the Mesozoic Neo-Tethyan Ocean and succeeding collision of the micro plates along the northern part of Turkey lead the development of the İzmir-Ankara-Erzincan suture zone (IAESZ). The suturing and collision stages terminate with the amalgamation of the three different crustal blocks (Pontides, Central Anatolian Crystalline Complex and Anatolide-Tauride Block) in the Paleocene-Early Eocene period. After the collisional stage; a new phase of extension and magmatism concomitantly developed at the both sides and as well as along the IAESZ during the Middle Eocene period. However, the origin, mechanism and driving force of the post-collisional magmatism is still enigmatic. To understand and better constrain the syn-to post collisional evolutionary stages, we have carried out volcano-stratigraphy and geochemistry based study on the middle Eocene magmatic associations along a transect ( 100 km) from Pontides to the Central Anatolian Crystalline Complex (CACC) at the NE part of the Turkey. Middle Eocene magmatic activity in the region has been represented by calc-alkaline, alkaline, shoshonitic volcanic and granitic rocks together with scarce gabbroic intrusions. We particularly focused on middle Eocene volcano-sedimentary successions (MEVSS) to constrain the tectono-magmatic evolution of the abovementioned transect. The volcano-sedimentary succsessions are coevally developed and cover the crustal blocks (Pontides and CACC) and the IAESZ with a region wide unconformity. We have differentiated three lava series (V1-V2-V3) and their sub-groups (V1a-V1b; V2a-V2b) in MEVSS. Generally, all lava series have middle-K to shoshonitic composition with distinct subduction characteristics. V1 series is marked by presence of hydrous phenocrysts such as amphibole+biotite. V1a sub-group constitute the first volcanic product and characterized by the high Mg# (42-69); alkaline basaltic andesite, and hawaiites. V1b sub-group is represented by calc-alkaline, low Mg# (24
Zeitler, P.K.; Tahirkheli, R.A.K.; Naeser, C.W.; Johnson, N.M.
The uplift history of the Swat Valley and Hazara region of northwestern Pakistan has been established using 22 fission-track dates on apatite, zircon and sphene. A major fault, the Main Mantle Thrust (MMT) strikes east-west across the Swat Valley, separates regions of markedly differing fission-track age regimesm, and may be a suture zone separating an extinct island arc terrane on the north from the Indian plate to the south. Fission-track ages ranging from about 55 to 58 m.y. for sphene, 18 to 53 m.y. for zircon, and 9 to 17 m.y. for apatite were obtained from the region north of the MMT. To the south the fission-track age ranges are 20 to 25 m.y. for sphene, 17 to 26 m.y. for zircon, and 16 to 23 m.y. for apatite. Disparate zircon and sphene ages on each side of the MMT imply different cooling histories for each side of the fault prior to 15 m.y. Similar apatite ages on both sides of the fault imply similar cooling histories during the past 15 m.y. This may indicate that faulting ceased by 15 m.y. Mean uplift rates have been derived from the fission-track data using mainly the mineral-pair method. Uplift rates in the region north of the MMT increased from 0.07 to 0.20 mm/yr during the period 55 to 15 m.y. South of the fault, uplift rates averaged in excess of 0.70 mm/yr for the period 25 to 15 m.y. During the past 15 m.y. uplift across the MMT in the Swat Valley showsno discontinuities, ranging from 0.16 mm/yr in the south to 0.39 mm/yr in the north. A plausible interpretation for the fission-track uplift data has the MMT verging to the south with overthrusting taking place at a depth between 3.5 and 6.0 km, juxtaposing two terranes that were originally separated by a substantial, but unknown distance. In this model, regional uplift followed cessation of faulting just prior to 15 m.y. ?? 1982.
Puziewicz, Jacek; Polkowski, Marcin; Grad, Marek
High-quality seismic data on the lower crust and uppermost lithospheric mantle in the Central European part of the Trans European Suture Zone, together with thermal and gravimetric data, enables the quantitative modeling of the rocks occurring in those parts of the lithosphere, including their mineral compositions and the chemical composition of individual minerals. The P3 seismic profile is located at the SW margin of the East European Craton. The lower crust is dominated by gabbronoritic intrusions (plagioclase An45Ab55, clinopyroxene Di80Hed20, orthopyroxene En74Fs26), and the uppermost mantle is harzburgitic (olivine and orthopyroxene Mg# 0.91). The lower crust and upper mantle of the P1 seismic profile belong to the Trans European Suture Zone, albeit the upper crust is of Variscan affinity. The P1 lower crust has gabbronoritic composition which is layered from plagioclase-rich compositions on the top to the orthopyroxene-rich ones at the bottom (plagioclase An45Ab55, clinopyroxene Di80Hed20, orthopyroxene En85Fs15), and is lithologically different Proterozoic and Variscan surroundings. The 100 × 200 km eclogite slice (garnet Alm48Gr25Py27, clinopyroxene Di51Hed10Jd39), with a thickness of 5-10 km, occurs in the uppermost mantle sampled by the P1 profile. The Niedźwiedź Massif is located at the NE margin of the Bohemian Massif, which shows an exposed Variscan basement. The lower crust beneath the Niedźwiedź Massif consists of gabbroic rock of variable proportions of plagioclase (An45Ab55) and clinopyroxene (Di80Hed20), whereas the uppermost mantle is supposedly spinel harzburgite (olivine, ortho- and clinopyroxene Mg# 0.90). Our models show that the lowermost crust and uppermost mantle of the East European Craton do not continue to the SW into the Trans European Suture Zone in its Central European section in Poland.
Cogne, J.; Kravchinsky, V.; Gilder, S.; Hankard, F.
The Paleozoic Mongol-Okhotsk Ocean separated the Siberian craton to the north from a landmass composed of Amuria, Tarim, Qaidam, Tibet and the North and South China blocks to the south. Based on a comparison of paleomagnetic data from the NCB with the Eurasian apparent polar wander path, this ocean closed by the beginning of the Cretaceous. We present here a review of recent paleomagnetic studies of Late Permian to Early Cretaceous formations from the Transbaikal area of south Siberia, coming from localities situated on both sides of the Mongol-Okhotsk suture zone. The main conclusions that we draw from these studies are as follows. (1) A Late Permian ~4500 km latitude difference indeed existed between Amuria and the Siberia blocks at 110°E longitude. (2) In Middle-Late Jurassic times, a 1700 to 2700 km paleolatitudinal gap still existed between the two blocks. This contradicts geological interpretations of a Middle Jurassic closure of the ocean at this longitude. (3) Consistency of Early Cretaceous paleolatitudes from both sides of the suture demonstrates the closure of the ocean at that time. Altogether, these suggest a quite fast closure between the Middle Jurassic and the Early Cretaceous, at about 15±11 cm/yr. Finally, all pre-Late Cretaceous paleomagnetic poles appear to be distributed along small-circles centered on site localities. We think this is due to continued deformation acting in the Mongol-Okhotsk suture region related to suturing. Conversely, the post-Early Cretaceous rotations may be related to Tertiary deformation under the effect of the India-Asia collision.
The Palghat-Cauvery Suture Zone (PCSZ) in the southern granulite terrane, India, which separates Pan-African granulite blocks (e.g., Madurai and Trivandrum Blocks) to the south and Archean terrane (e.g., Salem Block and Dharwar Craton) to the north is regarded as a major suture zone in the Gondwana collisional orogeny. It probably continues westwards to the Betsimisaraka suture in Madagascar, and eastwards into Sri Lanka and possibly into Antarctica. The available geochronological data including U-Pb zircon and EPMA monazite ages indicate that the rocks along the PCSZ underwent an episode of high-grade metamorphism at ca. 530 Ma that broadly coincides with the time of final assembly of the Gondwana supercontinent. Recent investigations on high-grade metamorphic rocks in this region have identified several new occurrences of garnet-clinopyroxene rocks and associated meta-gabbros from Perundurai, Paramati, Aniyapuram, Vadugappatti, and Mahadevi areas in Namakkal region within the central domain of the PCSZ. They occur as elongated boudins of 1 m to 1 km in length within hornblende-biotite orthogneiss. The garnet-clinopyroxene mafic granulites contain coarse-grained (up to several cm) garnet (Alm30-50 Pyr30-40 Grs10-20) and clinopyroxene (XMg = 0.70-0.85) with minor pargasite, plagioclase (An30-40), orthopyroxene (hypersthene), and rutile. Garnet and clinopyroxene are both subidioblastic and contain few inclusions of clinopyroxene (in garnet) and plagioclase. Orthopyroxene occur only as Opx + Pl symplectite between garnet and clinopyroxene in almost all the localities, suggesting the progress of decompressional reaction: Grt + Cpx + Qtz => Opx + Pl, which is a dominant texture in the PCSZ. The prograde mineral assemblage of the rocks is therefore inferred to be Grt + Cpx + Qtz, although quartz was probably totally consumed by the progress of the reaction. The metamorphic P-T calculations using Grt-Cpx-Pl-Qtz geothermobarometers yield T = 850-900°C and P >13 kbar
Melih Çörtük, Rahmi; Faruk Çelik, Ömer; Özkan, Mutlu; Sherlock, Sarah C.; Marzoli, Andrea; Altıntaş, İsmail Emir; Topuz, Gültekin
The İzmir-Ankara-Erzincan suture zone in northern Turkey is one of the major tectonic zones separating the Pontides to the North from the Anatolide-Tauride block and Kı rşehir Massif to the South. The accretionary complex of the İzmir-Ankara-Erzincan suture zone, near Artova, is composed mainly of peridotites with varying degree serpentinization, metamorphic rocks, basalt, sandstones, pelagic and neritic limestones. The metamorphic rocks are represented by amphibolite, garnet micaschit, calc-schist and marble. The metamorphic rocks were interpreted as the metamorphic sole rocks. Because; (i) They are tectonically located beneath the serpentinized peridotites. (ii) Foliation planes of both the amphibolites and mantle tectonites are parallel to each other. (iii) The metamorphic rocks are crosscut by non-metamorphic dolerite dikes which exhibite Nb and Ta depletion relative to Th enrichment on the N-MORB normalized multi-element spider diagram. The dolerite dikes display flat REE patterns (LaN/YbN=0.85-1.24). These geochemical signatures of the dolerite dikes are indicative of subduction component during their occurrences. Geochemical observations of the amphibolites suggest E-MORB- and OIB-like signatures (LaN/SmN= 1.39-3.14) and their protoliths are represented by basalt and alkali basaltic rocks. Amphiboles from the amphibolites are represented by calcic amphiboles (magnesio-hornblende, tchermakite and tremolite) and they yielded 40Ar-39Ar ages between 157.8 ± 3.6 Ma and 139 ± 11 Ma. These cooling ages were interpreted to be the intra-oceanic subduction/thrusting time of the İzmir-Ankara-Erzincan oceanic domain. This study was funded by TÜBİTAK (Project no: 112Y123).
McGrath, Daniel J.
Understanding ice shelf structure and processes is paramount to future predictions of sea level rise, as nearly 75% of the ice flux from the Antarctic Ice Sheet (AIS) passes through these gates. The breakup of an ice shelf removes the longitudinal back stress acting on the grounded inland ice and leads to flow acceleration, dynamic thinning and frontal retreat, processes that can be sustained for more than a decade. Increased ice discharge to the ocean contributes to global sea level rise. This dissertation investigates basal crevasses and suture zones, two key structural components of ice shelves, in order to understand how the structure of an ice shelf influences its stability in a warming climate. Ground penetrating radar, high-resolution satellite imagery and a variety of modeling approaches are utilized to assess these features on the Larsen C Ice Shelf but in a manner that considers their influence on ice shelf stability around the AIS. Basal crevasses are large-scale (~66% of ice thickness and ten's of kms in length) and abundant features that are significant structural weaknesses. The viscoplastic deformation of the ice shelf in response to the perturbed hydrostatic balance leads to the formation of both surface depressions and crevasses, hence weakening the ice shelf further. Basal crevasses increase the local ice-ocean interface by ~30%, thereby increasing basal roughness and altering ice-ocean interactions. Ice-shelf fractures frequently terminate where they encounter suture zones, regions of material heterogeneity that form at the lateral bounds of meteoric inflows to ice shelves. The termination of a 25 km-long rift in the Churchill Peninsula suture zone is investigated and found to contain ~60 m of accreted marine ice. Steady-state basal melting/freezing rates are determined for the ice shelf and applied to a flowline model to examine the along-flow evolution of ice shelf structure. The thickening surface wedge of locally accumulated meteoric ice
Kelemen, Peter; Hacker, Bradley
Some Himalayan cross-sections show Indian crust thrust beneath Tibetan crust, with no intervening mantle wedge (e.g., Powell & Conaghan 73), others indicate thickening of both crustal sections, juxtaposed along a steep suture (e.g., Dewey & Burke 73), and many combine features of both end-members (e.g., Argand 24). To understand crustal scale structure and related phenomena, we focus on data from an area in southern Tibet at 28-30°N, 84-91°E. 21st century observations in this area show a horizontal Moho at ca 80 km depth, extending from thickened Indian crust, across a region where Tibetan crust is interpreted to overlie Indian crust, into thickened Tibetan crust (Zhao et al 01; Monsalve et al 08; Wittlinger et al 09; Nabelek et al 09; Kind et al 02; Schulte-Pelkum et al 05; Shi et al 15). About half the subducted Indian crustal volume is present, whereas the other half is missing (Replumaz et al 10). Vp/Vs indicates the alpha-beta quartz transition is at ca 50 km depth (Sheehan et al 13). Miocene lavas include primitive andesites probably formed by interaction of crustal material with mantle peridotite at > 1000°C (Turner et al 93; Williams et al 01, 04; Chung et al 05). Thermobarometry of xenoliths in a 12.7 Ma dike records ~ 1100°C at 2.2-2.6 GPa and 920°C at 1.7 GPa (Chan et al 09). Biotite-rich pyroxenites among the xenoliths, similar to those in central Tibet (Hacker et al 00) and the Pamirs (Hacker et al 05), may form via reaction of hot crustal lithologies and mantle peridotite (e.g., Sekine & Wyllie 82, 83). These data, taken together, indicate Miocene to present day temperatures exceeding 800°C from ca 50 km depth to the Moho, unlike thermal models with a hot mid-crust and cold Moho (McKenzie & Priestley 08, Craig et al 12, Wang et al 13; Nabelek & Nabelek 14), and despite the observation of numerous, near-Moho earthquakes (Chen & Molnar 83; Chen & Yang 04; Monsalve et al 06; Priestley et al 08; Craig et al 12) interpreted by many as brittle failure
Li, Shun; Guilmette, Carl; Ding, Lin; Xu, Qiang; Fu, Jia-Jun; Yue, Ya-Hui
The Bangong-Nujiang suture zone, separating the Lhasa and Qiangtang blocks of the Tibetan Plateau, is marked by remnants of the Bangong-Nujiang oceanic basin. In the Gaize area of central Tibet, Mesozoic sedimentary strata recording the evolution of the basin and subsequent collision between these two blocks include the Upper Triassic-Lower Jurassic turbidites of the Mugagangri Group, the Upper Jurassic-Lower Cretaceous sandstone-dominated Wuga and Shamuluo formations, and the Upper Cretaceous molasse deposits of the Jingzhushan Formation. The Shamuluo and Jingzhushan formations rest unconformably on the underlying Mugagangri Group and Wuga Formation, respectively. In this contribution, we analyze petrographic components of sandstones and U-Pb-Hf isotopic compositions of detrital zircons from the Wuga and Jingzhushan formations for the first time. Based on the youngest detrital zircon ages, the maximum depositional ages of the Wuga and Jingzhushan formations are suggested to be ∼147-150 Ma and ∼79-91 Ma, respectively. Petrographic and isotopic results indicate that sediments in the Wuga Formation were mainly sourced from the accretionary complex (preserved as the Mugagangri Group) in the north, while sediments in the Jingzhushan Formation have mixed sources from the Lhasa block, the Qiangtang block and the intervening suture zone. Provenance analysis, together with regional data, suggests that the Upper Jurassic-Lower Cretaceous Wuga and Shamuluo formations were deposited in a peripheral foreland basin and a residual-sea basin, respectively, in response to the Lhasa-Qiangtang collision, whereas the Upper Cretaceous Jingzhushan Formation reflects continental molasse deposition during the post-collisional stage. The development of the peripheral foreland basin evidenced by deposition of the Wuga Formation reveals that the age of the initial Lhasa-Qiangtang collision might be the latest Jurassic (∼150 Ma).
Balen, D.; Schneider, P.; Massonne, H. J.; Opitz, J.; Petrinec, Z.
The Cretaceous suture zone between the colliding plates of European and Adria (Gondwana) marks the closure of the W Neotethys branch. This zone, partly located in the northern Croatia, comprises reddish alkali granite which is mainly composed of alkali feldspar and quartz, with small amounts of albite, white mica and hematite with ilmenite exsolutions. Accessory minerals include zircon, apatite and Fe-(Ti)-oxides. This granite shows a geochemical signature typical for A2-type granite characterized by a highly siliceous composition and an enrichment in alkalies (high-K calc-alkaline series) and Al (strongly peraluminous, ASI>1.1). The rock belongs to the group of oxidized and ferroan granites with low CaO, MgO, MnO and FeO* contents. Characteristic trace element ratios, primitive mantle and OIB normalized spider-diagrams show significant positive anomalies of Rb, Th, U, K, Zr and Pb accompanied with clear negative anomalies of Ba, Nb, Sr, P, Eu and Ti. The negative anomalies suggest fractionation of plagioclase, apatite and Fe-Ti oxide. Based on the geochemical characteristics the magma originated mainly from melting of lower continental crust (granulite facies metasediments) although a mantle contribution cannot be excluded. The melting process could have been triggered by a heat from the upwelling upper mantle as inferred from zircon typology (D and J5 types prevail), as well from the zircon and whole-rock chemistry accompanied with high zircon saturation temperatures (T=860-950°C). Subsequent ascent of granitic magma was localized along the Europe-Adria suture i.e. the Sava Zone segment of the Late Cretaceous collisional zone where granite was emplaced at ca. 20 km depth. The emplacement followed a long period of Mesozoic orogenic compressional activity. Typical for A-type granites, although in our case related to the subduction of the Adria plate underneath the European plate, is their formation in an extensional tectonic regime. Thus, the studied A
Scholl, D. W.; von Huene, Roland E.
Arc magmatism at subduction zones (SZs) most voluminously supplies juvenile igneous material to build rafts of continental and intra-oceanic or island arc (CIA) crust. Return or recycling of accumulated CIA material to the mantle is also most vigorous at SZs. Recycling is effected by the processes of sediment subduction, subduction erosion, and detachment and sinking of deeply underthrust sectors of CIA crust. Long-term (>10-20 Ma) rates of additions and losses can be estimated from observational data gathered where oceanic crust underruns modern, long-running (Cenozoic to mid-Mesozoic) ocean-margin subduction zones (OMSZs, e.g. Aleutian and South America SZs). Long-term rates can also be observationally assessed at Mesozoic and older crust-suturing subduction zone (CSSZs) where thick bodies of CIA crust collided in tectonic contact (e.g. Wopmay and Appalachian orogens, India and SE Asia). At modern OMSZs arc magmatic additions at intra-oceanic arcs and at continental margins are globally estimated at c. 1.5 AU and c. 1.0 AU, respectively (1 AU, or Armstrong Unit,= 1 km3 a-1 of solid material). During collisional suturing at fossil CSSZs, global arc magmatic addition is estimated at 0.2 AU. This assessment presumes that in the past the global length of crustal collision zones averaged c. 6000 km, which is one-half that under way since the early Tertiary. The average long-term rate of arc magmatic additions extracted from modern OMSZs and older CSSZs is thus evaluated at 2.7 AU. Crustal recycling at Mesozoic and younger OMSZs is assessed at c. 60 km3 Ma-1 km-1 (c. 60% by subduction erosion). The corresponding global recycling rate is c. 2.5 AU. At CSSZs of Mesozoic, Palaeozoic and Proterozoic age, the combined upper and lower plate losses of CIA crust via subduction erosion, sediment subduction, and lower plate crustal detachment and sinking are assessed far less securely at c. 115 km3 Ma-1 km-1. At a global length of 6000 km, recycling at CSSZs is accordingly c. 0
Tremblay, Alain; Meshi, Avni; Deschamps, Thomas; Goulet, François; Goulet, Normand
The Dinarides-Hellenides result from underthrusting of the Adriatic margin during Africa-Europe convergence. In Albania, they consist of (1) a western zone of nappes derived from Adria; (2) a central belt made up of the Mirdita ophiolites; and (3) an eastern zone, the Korabi-Pelagonia zone, of Variscan basement overlain by Permian to Mesozoic rift deposits and carbonates. Some authors interpret the Korabi-Pelagonia zone as a microcontinent between the Mirdita-Pindos oceanic basin to the west and the eastern Vardar oceanic basin to the east; other regard the Korabi-Pelagonia zone as a tectonic window below a single ophiolitic nappe. This contribution argues for a far-traveled thrust sheet. The Mirdita ophiolites are 165-160 Ma. The metamorphic sole yielded 40Ar/39Ar ages of 171 to 162 Ma. The Korabi-Pelagonia zone is subdivided into the Korabi and Gjegjan subzones. The structural analysis of these rocks supports the rooting of the Mirdita ophiolites in the Western Vardar zone. The post-Variscan cover sequence of the Korabi subzone records two phases of deformation: D1 is associated with a SE dipping to flat-lying schistosity axial planar to NW verging folds and thrust faults, related to ophiolite obduction; D2 is a postobduction NNE trending crenulation cleavage. Published zircon fission track analyses yielded 150-125 Ma, suggesting that regional metamorphism is Early Cretaceous or older. K-Ar mica ages from correlative rocks of Macedonia cluster between 148 and 130 Ma, indicating that D1 is Late Jurassic. A west directed obduction is favored, as is a rooting east of the Mirdita ophiolites because of the top-to-the-west structural polarity of obduction-related deformation.
Lai, Wen; Hu, Xiumian; Zhu, Dicheng; An, Wei; Ma, Anlin
Mélange records a series of geological processes associated with oceanic subduction and continental collision. This paper reports for the first time the presence of Early Jurassic mélange from NW Nagqu in the southern margin of the Bangong-Nujiang suture zone, termed as the Gajia mélange. It shows typically blocks-in-matrix structure with matrix of black shale and siliceous mudstone, and several centimeters to several meters sized blocks of sandstone, silicalite, limestone and basalt. The sandstone blocks consist of homologous sandstone and two types of exotic sandstone, with different modal compositions. The Group 1 of exotic sandstone blocks consists of mainly of feldspar and quartz, whereas the Group 2 is rich in volcanic detritus. The Group 3 of homologous sandstone blocks is rich in feldspar and volcanic detritus with rare occurrence of quartz. U-Pb age data and in situ Hf isotopic compositions of detrital zircons from sandstone blocks are similar to those from the Lhasa terrane, suggesting that the sandstone blocks in the Gajia mélange most probably came from the Lhasa terrane. The YC1σ(2+) age of homologous sandstone blocks is 177 ± 2.4 Ma, suggesting an Early Jurassic depositional age for the sandstones within the Gajia mélange. The Gajia mélange likely records the southward subduction of the Bangong-Nujiang Ocean during the Early Jurassic.
DiBattista, Joseph D; Whitney, Jonathan; Craig, Matthew T; Hobbs, Jean-Paul A; Rocha, Luiz A; Feldheim, Kevin A; Berumen, Michael L; Bowen, Brian W
Closely related species can provide valuable insights into evolutionary processes through comparison of their ecology, geographic distribution and the history recorded in their genomes. In the Indo-Pacific, many reef fishes are divided into sister species that come into secondary contact at biogeographic borders, most prominently where Indian Ocean and Pacific Ocean faunas meet. It is unclear whether hybridization in this contact zone represents incomplete speciation, secondary contact, an evolutionary dead-end (for hybrids) or some combination of the above. To address these issues, we conducted comprehensive surveys of two widely-distributed surgeonfish species, Acanthurus leucosternon (N=141) and A. nigricans (N=412), with mtDNA cytochrome b sequences and ten microsatellite loci. These surgeonfishes are found primarily in the Indian and Pacific Oceans, respectively, but overlap at the Christmas and Cocos-Keeling Islands hybrid zone in the eastern Indian Ocean. We also sampled the two other Pacific members of this species complex, A. achilles (N=54) and A. japonicus (N=49), which are known to hybridize with A. nigricans where their ranges overlap. Our results indicate separation between the four species that range from the recent Pleistocene to late Pliocene (235,000-2.25million years ago). The Pacific A. achilles is the most divergent (and possibly ancestral) species with mtDNA dcorr≈0.04, whereas the other two Pacific species (A. japonicus and A. nigricans) are distinguishable only at a population or subspecies level (ΦST=0.6533, P<0.001). Little population structure was observed within species, with evidence of recent population expansion across all four geographic ranges. We detected sharing of mtDNA haplotypes between species and extensive hybridization based on microsatellites, consistent with later generation hybrids but also the effects of allele homoplasy. Despite extensive introgression, 98% of specimens had concordance between mtDNA lineage and
Jia, L.; Hong, Z.; Linglei, Z.; Yun, D.
The change of runoff has a great influence on global water cycle, and migration or transformation of biogenic matters. As the Tibet's most important economic region, the Yarlung Zangbo River basin is extremely sensitive and fragile to the global climate change. But the river is a typical lack-data basin, where the quantity of available runoff data is extremely limited and the spatial and temporal resolutions are very low. This study Chooses middle reaches of Yarlung Zangbo River basin as the study area, 4 models of Global Land Data Assimilation System (GLDAS) and the water balance equation are used to calculate surface runoff of Nuxia hydrological station from year of 2009 to 2013. Through the analysis of hydrological elements change, the impact of climate factors to surface runoff is discussed. At last, Statistical method is used to compare correlation and error between the 4 models results and in situ runoff observation. The Broke ranking method is applied to evaluate data quality and applicability of the 4 models in the Yarlung Zangbo River basin. The results reveal that the total runoff calculated from 4 models all have similar change cycle around 12 months, and the values all tend to have slight increase as in situ runoff data during research period. Moreover, it can conclude that the runoff time series show obvious period and mutation characters. During study period, monthly mean precipitation and temperature both have obvious seasonal variability, and the variation trend is relatively consistent. Through the analysis of the runoff affecting factors, it shows that the changes of precipitation and temperature are the most direct factors affecting runoff of the Yarlung Zangbo River. Correlation between precipitations, temperature with runoff of Nuxia hydrological station is good, and the correlation coefficients are in the range of 0.727 to 0.924.It shows that climate change controls basin runoff change to some extent. At last, runoff estimated from GLDAS
. Cytonuclear discordance in patterns of genetic structure and introgression at contact zones suggests selection may be involved at various scales. Suture zones are important areas for the study of lineage formation and speciation, and our results show that biogeographic barriers can yield markedly different phylogeographic patterns in different vertebrate and invertebrate taxa. PMID:24021154
Ali, Sarmad A.; Ismail, Sabah A.; Nutman, Allen P.; Bennett, Vickie C.; Jones, Brian G.; Buckman, Solomon
The Kata-Rash arc fragment is an allochthonous thrust-bound body situated near Penjween, 100 km northeast of Sulymannia city, Kurdistan Region, within the Iraqi portion of the Zagros suture zone. It forms part of the suprasubduction zone 'Upper Allochthon' terranes (designated as the Gimo-Qandil Group), which is dominated by calc-alkaline andesite and basaltic-andesite, rhyodacite to rhyolite, crosscut by granitic, granodioritic, and dioritic dykes. Previously, rocks of the Kata-Rash arc fragment were interpreted as a part of the Eocene Walash volcanic group. However, SHRIMP zircon U-Pb dates on them of 108.1 ± 2.9 Ma (Harbar volcanic rocks) and 107.7 ± 1.9 Ma (Aulan intrusion) indicate an Albian-Cenomanian age, which is interpreted as the time of igneous crystallisation. The Aulan intrusion zircons have initial εHf values of + 8.6 ± 0.2. On a Nb/Yb-Th/Yb diagram, all Kata-Rash samples fall within the compositional field of arc-related rocks, i.e. above the mid-ocean-ridge basalt (MORB)-ocean island basalt (OIB) mantle array. Primitive-mantle-normalised trace-element patterns for the Kata-Rash samples show enrichment in the large ion lithophile elements and depletion in the high-field-strength elements supporting their subduction-related character. Low Ba/La coupled with low La/Yb and Hf/Hf* < 1 for the Aulan sample with initial εHf of + 8.6 ± 0.2 is interpreted as the magma dominated by contributions from fluid fluxing of the mantle wedge and lesser contributions of low temperature melt from subducted slab sediment, in an oceanic setting. This mechanism can explain the sub-DM initial εHf value, without the need to invoke melting of significantly older (continental) crust in an Andean setting. We interpret the Kata-Rash igneous rocks as a fragment of the Late Cretaceous suprasubduction zone system (named here the Kata-Rash arc) that most likely developed within the Neotethys Ocean rather than at a continental margin. Subsequently during the latest Cretaceous
Wilde-Piórko, Monika; Świeczak, Marzena; Grad, Marek; Majdański, Mariusz
The structure and evolution of the Trans-European Suture zone (TESZ), contact between Precambrian Europe to the northeast and Phanerozoic terranes to the southwest is one of the main tectonic questions in Europe. The knowledge of the crustal structure, lithosphere-asthenosphere boundary and mantle transition zone between two seismic discontinuities at depths "410" and "660" km, is one of the most important issues to understand the Earth's dynamics. To create a mantle model of the TESZ and surroundings we used different seismic data collected along the 950 km long POLONAISE'97 profile P4. Previous results of 2-D ray-tracing and P-wave travel time modelling and new results of P-wave travel time residuals methods and receiver function sections provide facts about the seismic structure from the surface down to 900 km depth. In the TESZ a large basin, about 125 km wide, is filled with sedimentary strata (Vp < 6.0 km s - 1 ) to about 20 km depth. This basin is asymmetric with its northeast margin being most abrupt. The crystalline crust under this basin is only about 20 km thick today indicating that the lithosphere of Baltica was either thinned drastically or terminated along the northeast margin of the basin. The East European craton (EEC) has a ~ 45 km thick three-layered crust. The crust of the accreted terranes to the southwest is relatively thin (~ 30 km) and similar to that found in other non-cratonal areas of Western Europe. The lower crust is relatively fast (Vp > 7.0 km s - 1 ) along most of the P4 profile. However, lower values to the southwest may indicate the termination of Baltica. High velocity (~ 8.35 km s - 1 ) uppermost mantle lies beneath the Avalonia/Variscan terranes, and may be due to rifting and/or subduction. The seismic lithosphere thickness for the EEC is about 200 km, while it is only 90 km in the Palaeozoic platform (PP). The mantle transition zone is shallower and about 30 km thicker under the EEC, which could be due to thermal conditions
Zhang, Xiu-Zheng; Wang, Qiang; Dong, Yong-Sheng; Zhang, Chunfu; Li, Qing-Yun; Xia, Xiao-Ping; Xu, Wang
The geometric transformation of a descending plate, such as from steep to flat subduction in response to a change from normal to overthickened oceanic crust during subduction, is a common and important geological process at modern or fossil convergent margins. However, the links between this process and the metamorphic evolution of the exhumation of oceanic (ultra)high-pressure eclogites are poorly understood. Here we report detailed petrological, mineralogical, phase equilibria, and secondary ion mass spectrometry zircon and rutile U-Pb age data for the Dong Co eclogites at the western segment of the Bangong-Nujiang suture zone, central Tibet. Our data reveal that the Dong Co eclogites experienced peak eclogite-facies metamorphism (
Bhattacharya, G.; Robinson, D. M.; Orme, D. A.; Olree, E.; Bosu, S.
Detritus from the India-Asia collision and subsequent Cenozoic tectonic events is preserved in sedimentary basins along the 2500 km long Indus-Yarlung Suture Zone (IYSZ) in India and Tibet. In northwest India, these Eocene-Miocene synorogenic sedimentary rocks are preserved in the Tar and Indus Groups. We use (U-Th)/He dating of detrital zircons from units within these sedimentary basins, including the Temesgam Formation at Temesgam, the Lower Nimu Formation and the Sumdo Formation in the Zanskar Gorge, and the Artsa Formation and the Miru Formation in the Upshi-Lato region. These analyses indicate a phase of rapid exhumation from 19-8 Ma. Possible explanations for these data include a combination of tectonic events and the influence of climate. Regional back-thrusting initiated at 20 Ma along the Great Counter Thrust, which buried the IYSZ footwall with the Lamayuru slope deposits of the Indian passive margin. In south Tibet, previous studies identify underthrusting of the Indian plate as a key factor for basin exhumation in the IYSZ, which may also be a driver in northwest India. The flow of the paleo-Indus river through the IYSZ in Early Miocene time might have been triggered by the onset of Asian monsoon at 24 Ma and its intensification between 18-10 Ma. Our data demonstrate a phase of rapid exhumation in northwest India from 19-8 Ma, which may be linked to all of these tectonic and climate influences. Data in this study are similar to the data of Carrapa et al. (2014) from south Tibet that show peak exhumation at 17 Ma, and suggest that a regional cooling episode, driven by tectonics and climate, might have prevailed in the Miocene along the IYSZ.
Harlow, George E.; Flores, Kennet E.; Marschall, Horst R.
Jadeitites in serpentinite mélanges are the product of crystallization from and/or metasomatism by aqueous fluids that transfer components from and within a subduction channel-the slab-mantle interaction volume-into discrete rock units, most commonly found within the serpentinized or serpentinizing portion of the channel or the overlying mantle rocks at high pressure (1 to > 2 GPa). Two serpentinite mélanges on either side of the Motagua fault system (MFS) of the Guatemala Suture Zone contain evidence of this process. Whole rock compositional analyses are reported here from 86 samples including jadeitites and the related rocks: omphacitites, albitites and mica rocks. The predominance of a single phase in most of these rocks is reflected in the major element compositions and aspects of the trace elements, such as REE abundances tracking Ca in clinopyroxene. Relative to N-MORB all samples show relative enrichments in the high field strength elements (HFSE) Hf, Zr, U, Th, and the LILE Ba and Cs, contrasted by depletions in K and in some cases Pb or Sr. Most jadeitites are also depleted in the highly compatible elements Cr, Sc and Ni despite their occurrence in serpentinite mélange; however, some omphacitite samples show the opposite. Trace elements in these jadeitite samples show a strong similarity with GLOSS (globally subducted oceanic sediment) and other terrigenous sediments in terms of their trace-element patterns, but are offset to lower abundances. Jadeitites thus incorporate a strong trace-element signature derived from sediments mixed with that from fluid derived from altered oceanic crust. Enrichment in the HFSE argues for mobility of these elements in aqueous fluids at high P/T conditions in the subduction channel and a remarkable lack of fractionation that might otherwise be expected from dissolution and fluid transport.
Lenaz, Davide; Mazzoli, Claudio; Spišiak, Jan; Princivalle, Francesco; Maritan, Lara
The Šambron-Kamenica Zone is situated on the northern margin of the Levočské vrchy mountains and Šarišskà vrchovina Highland, where the Central Carpathian Paleogene joins the Pieniny Klippen Belt. Sandstone outcrops in this area. From Cretaceous to Late Oligocene in age, these sediments suggest transport directions from S and SE. The heavy mineral assemblages of this sandstone include Cr-spinel grains, mainly displaying types II and III alpine-peridotite affinities, and are representative of Ocean Island Basalt volcanism. A sample from Upper Eocene sediments at Vit’az shows a clear change in Cr-spinel composition, which turns out to have types I and II peridotite affinities, and to derive from arc and Middle Ocean Ridge Basalt volcanism, with sediment transport directions from SW and WSW. These data indicate major variations in the Upper Eocene tectonic setting, giving constraints to paleogeographic reconstruction of the Slovak Central Carpathians.
Steltenpohl, M.G.; Mueller, P.M.; Heatherington, A.L.; Hanley, T.B.; Wooden, J.L.
The poorly known, suspect, Uchee terrane occupies a critical tectonic position with regard to how and when peri-Gondwanan (Carolina) and Gondwanan (Suwannee) terranes were sutured to Laurentia. It lies sandwiched between Laurentian(?) continental basement exposed in the Pine Mountain window and adjacent buried Gondwanan crust of the Suwannee terrane. The Uchee terrane has been proposed as both a septum of Piedmont rocks that once was continuous across the erosionally breached Pine Mountain window or part of the Carolina zone. To help resolve this issue, we conducted U-Pb (SHRIMP-RG) (sensitive high-resolution ion microprobe-reverse geometry) zircon studies and whole-rock isotopic analyses of principal metasedimentary and metaplutonic units. U-Pb ages for zircons from the Phenix City Gneiss suggest igneous crystallization at ca. 620 Ma, inheritance ca. 1000 to ca. 1700 Ma, and a ca. 300 Ma (Alleghanian) overprint recorded by zircon rims. Zircons from the metasedimentary/metavolcaniclastic Moffits Mill Schist yield bimodal dates at ca. 620 and 640 Ma. The 620 to 640 Ma dates make these rocks age-equivalent to the oldest parts of the Carolina slate belt (Virgilina and Savannah River) and strongly suggest a Gondwanan (Pan-African and/or Trans-Brasiliano) origin for the Uchee terrane. Alternatively, the Uchee terrane may be correlative with metamorphic basement of the Suwannee terrane. The ca. 300 Ma overgrowths on zircons are compatible with previously reported 295 to 288 Ma 40Ar/39Ar hornblende dates on Uchee terrane rocks, which were interpreted to indicate deep tectonic burial of the Uchee terrane contemporaneous with the Alleghanian orogeny recorded in the foreland. Temperature-time paths for the Uchee terrane are similar to that of the Pine Mountain terrane, indicating a minimum age of ca. 295 Ma for docking. In terms of tectono-metamorphic history of the Uchee terrane, it is important to note that no evidence for intermediate "Appalachian" dates (e.g, Acadian or
Cameron, Bruce D.; Joos, Karen M.; Shen, Jin-Hui
Purpose: To develop a simple suture lysis technique for post-trabeculectomy examinations under anesthesia since slit lamp laser suture lysis in the clinic cannot be performed on infants and young children. Methods: An argon endolaser probe lysed 10-0 nylon suture through conjunctiva harvested from human cadaver eyes. Since suture lysis failed with the thick Hoskins lens, clear plastic from the suture package compressed the conjunctiva. The conjunctiva was examined histologically. Results: Argon laser suture lysis (250 mW, 0.1 sec, 488 - 514 nm) was achieved without conjunctival damage. Conclusion: The argon endolaser probe is effective for suture lysis when the slit lamp cannot be used.
Saitoh, Yohsuke; Tsunogae, Toshiaki; Santosh, M.; Chetty, T. R. K.; Horie, Kenji
We report the metamorphic pressure-temperature ( P- T) history of mafic granulites from two localities in southern India, one from Kanja Malai in the northern margin and the other from Perundurai in the central domain of the Palghat-Cauvery Suture Zone (PCSZ). The PCSZ is described in recent models as the trace of the suture along which crustal blocks were amalgamated within the Gondwana supercontinent during Late Neoproterozoic-Cambrian. The mafic granulite from Kanja Malai yields P- T conditions of 750-800 °C and 8-12 kbar reflecting the partially retrograded conditions following a peak high-pressure (HP) metamorphic event. The common Grt + Cpx + Qtz assemblage in these rocks and lack of decompression texture suggest that peak metamorphism was probably buffered by Grt + Cpx + Opx + Pl + Qtz assemblage, following which the rocks were exhumed through a gradual P- T decrease. The mafic granulite from Perundurai (Grt + Cpx + Pl) contains Opx + Pl symplectite commonly occurring between garnet and clinopyroxene, suggesting the progress of reaction: Grt + Cpx + Qtz → Opx + Pl, with the Grt + Cpx + Qtz representing the peak metamorphic assemblage. The reaction microstructures and calculated P- T conditions suggest that the mafic granulites from Perundurai underwent peak HP metamorphism at P > 12 kbar and T = 800-900 °C and subsequent isothermal decompression along a clockwise P- T path, in contrast to the P- T path inferred for Kanja Malai. The contrasting P- T paths obtained from the two localities suggest that whereas Perundurai is a part of the metamorphic orogen developed within the PCSZ during Gondwana assembly, the high-pressure granulites of Kanja Malai belong to a different orogenic regime. In order to evaluate this aspect further, we analyzed zircons in a charnockite and garnet-bearing quartzo-feldspathic gneiss associated with the HP granulites from Kanja Malai which yielded mean 207Pb/ 206Pb magmatic protolith emplacement ages of 2536.1 ± 1.4 Ma and 2532
New insight on the paleoproterozoic evolution of the São Francisco Craton: Reinterpretation of the geology, the suture zones and the thicknesses of the crustal blocks using geophysical and geological data
Sampaio, Edson E. S.; Barbosa, Johildo S. F.; Correa-Gomes, Luiz C.
The Archean-Paleoproterozoic Jequié (JB) and Itabuna-Salvador-Curaçá (ISCB) blocks and their tectonic transition zone in the Valença region, Bahia, Brazil are potentially important for ore deposits, but the geological knowledge of the area is still meager. The paucity of geological information restricts the knowledge of the position and of the field characteristics of the tectonic suture zone between these two crustal segments JB and ISCB. Therefore, interpretation of geophysical data is necessary to supplement the regional structural and petrological knowledge of the area as well as to assist mining exploration programs. The analysis of the airborne radiometric and magnetic data of the region has established, respectively, five radiometric domains and five magnetic zones. Modeling of a gravity profile has defined the major density contrasts of the deep structures. The integrated interpretation of the geophysical data fitted to the known geological information substantially improved the suture zone (lower plate JB versus upper plate ISCB) delimitation, the geological map of the area and allowed to estimate the thicknesses of these two blocks, and raised key questions about the São Francisco Craton tectonic evolution.
Preliminary Thermo-Chronometric and Paleo-Magnetic Results from the Western Margin of The Kırşehir Block: Implications for the Timing of Continental Collisions Occurred Along Neo-Tethyan Suture Zones (Central Anatolia, Turkey)
Gülyüz, Erhan; Özkaptan, Murat; Langereis, Cor G.; Kaymakcı, Nuretdin
Closures of Paleo- (largely Paleozoic) and Neo-Tethys (largely Mesozoic) Oceans developed between Europe, Africa and Arabia are the main driving mechanisms behind the post-Triassic tectonics, magmatism and metamorphism occurred in Anatolia. Although various scenarios have been suggested for the timing and characteristics of the subduction systems, it is largely accepted that these blocks are progressively collided and amalgamated along the northern (İzmir-Ankara-Erzincan suture zone; IAESZ) and the southern (Bitlis-Zagros suture zone; BZSZ) branches of Neo-Tethys Ocean. The geographic positions of these suture zones in Anatolia are marked by imbricated stacks of largely metamorphosed remnants of the Paleo- and Neo-Tethys Oceans. In addition to this tectonic frame, the existence of another suture zone within the northern branch of the Neo-Tethys separating the Kırşehir Block, a triangular (200km*200km*200km) continental domain represented by mainly high-pressure (HP) meta-sedimentary rocks, from the Taurides, is proposed and named as Intra-Tauride Suture Zone (ITSZ). Although traces of the Neo-Tethyan closure and continental collisions in the Central Anatolia are recorded (1) in sedimentary basins as fold and thrust belt developments (as northern Taurides fold and thrust belt along IAESZ and central Taurides fold and thrust belt along ITSZ), (2) on metamorphic rocks with Late Cretaceous to Late Paleocene peak metamorphism, and (3) on magmatic rocks with Late Cretaceous - Paleocene arc-related intrusions and post-Paleocene post-collisional magmatism, timing of these continental collisions are discussed in limited studies and furthermore they indicate a large time span (post-Paleocene to Miocene) for the collisions. This study aims to date continental collisions occurred in Central Anatolia qualitatively. In this regard, low-temperature thermo-chronometric and paleo-magnetic studies were conducted on the sedimentary units cropped-out along the western and north
Fritschle, Tobias; Daly, J. Stephen; Whitehouse, Martin J.; McConnell, Brian; Buhre, Stephan
Late Caledonian syn- to post-orogenic granites located in the Iapetus Suture Zone (ISZ) in Ireland and Britain have been related to A-type subduction and possible slab breakoff  following the Laurentia-Avalonian collision. Lack of reliable age data (especially in Ireland) has inhibited petrogenetic investigations of these rocks. Hence, ion microprobe U-Pb and oxygen isotope analyses as well as LA-MC-ICPMS Lu-Hf isotopic measurements on zircons from Irish and Isle of Man granites have been undertaken to provide better constraints on this enigmatic episode of the Caledonian Orogeny. Four stages of Late Caledonian granitic magmatism (c. 435, 417, 410 and 394 Ma) are indicated by U-Pb dating of oscillatory-zoned magmatic zircons. The Crossdoney, Kentstown, Drogheda and Ballynamuddagh granites together with a rhyolite from Glenamaddy have yielded U-Pb concordia ages, interpreted as intrusion-ages, between 419.9 ± 4.3 Ma (Glenamaddy) and 415.8 ± 2.0 Ma (Crossdoney) with a weighted average of 417.5 ± 0.9 Ma (MSWD = 1.3). The Glenamaddy Granite - which intruded the Glenamaddy Rhyolite - yielded an age of 410 ± 2.1 Ma. In addition, the Rockabill Granite yielded a younger age of 393.9 ± 1.9 Ma, whereas the Carnsore Granite yielded an older age of 434.6 ± 1.9 Ma. Inherited zircons (487 to 453 Ma) occur in several of the granites, and are interpreted to have been derived from Ordovician arc magmatic rocks accreted within the ISZ. A younger group of c. 440 Ma inherited zircons occurs in the c. 417 Ma Crossdoney and Ballynamuddagh granites. These grains could be related to continued or renewed Silurian arc magmatism. Hf-O isotopic measurements on the dated zircon grains range between -2 and +7 ɛHfi units and 5.5 to 8.5 o δ18O. These are interpreted to indicate the contribution of juvenile mantle melts - possibly derived from the Ordovician arc - to some of the granites. Significant heterogeneities in zircon oxygen isotopes in at least four of the granites further
Han, Xianming; Zuo, Depeng; Xu, Zongxue; Cai, Siyang; Gao, Xiaoxi
The Yarlung Zangbo River Basin is located in the southwest border of China, which is of great significance to the socioeconomic development and ecological environment of Southwest China. Normalized Difference Vegetation Index (NDVI) is an important index for investigating the change of vegetation cover, which is widely used as the representation value of vegetation cover. In this study, the NDVI is adopted to explore the vegetation condition in the Yarlung Zangbo River Basin during the recent 17 years, and the relationship between NDVI and meteorological variables has also been discussed. The results show that the annual maximum value of NDVI usually appears from July to September, in which August occupies a large proportion. The minimum value of NDVI appears from January to March, in which February takes up most of the percentage. The higher values of NDVI are generally located in the lower elevation area. When the altitude is higher than 3250 m, NDVI began to decline gradually, and the NDVI became gradual stabilization as the elevation is up to 6000 m. The correlation coefficient between NDVI and precipitation in the Yarlung Zangbo River Basin is greater than that with temperature. The Hurst index of the whole basin is 0.51, indicating that the NDVI of the Yarlung Zangbo River Basin shows a weak sustainability.
Huo, Bin; Xie, Cong Xin; Madenjian, Charles P.; Ma, Bao Shan; Yang, Xue Feng; Huang, Hai Ping
Feeding habits of Oxygymnocypris stewartii were investigated based on monthly sampling in the Yarlung Zangbo River from August 2008 to August 2009. The gut contents of 194 individuals were analysed and quantified with numerical and gravimetric methods. This species can be considered a generalized and opportunistic predator feeding both on teleosts and aquatic insects. A multivariate analysis revealed noticeable variation in O. stewartii diet composition with fish size and season. The smaller specimens fed primarily on Cobitidae and Hydropsychidae. As they grew, Cyprinidae and Chironomidae larvae became important prey. The preferred food items were teleosts in summer and autumn. For winter and spring, the predominant prey switched to chironomidae larvae. Diet composition did not significantly vary between the sexes. Finally, a significant and positive correlation between predator and prey length was found. These findings provide the fundamental information better understanding the role of this important endemic species in the Yarlung Zangbo River food web.
Toljić, Marinko; Matenco, Liviu; ÄErić, Nevenka; Milivojević, Jelena; Gerzina, Nataša.; Stojadinović, Uros
The Fru\\vska Gora Mountains in northern Serbia offers an unique opportunity to study the Cretaceous-Eocene evolution of the NE part of the Dinarides, which is largely covered elsewhere beneath the thick Miocene sediments of the Pannonian basin, deposited during the back-arc collapse associated with the subduction and roll-back recorded in the external Carpathians. The structural grain of the Fru\\vska Gora Mountains is the one of a large scale antiform, exposing a complex puzzle of highly deformed metamorphic rocks in its centre and Triassic-Miocene sequence of non-metamorphosed sediments, ophiolites and volcanics along its flanks. The metamorphic rocks were the target of structural investigations coupled with paleontological dating (conodonts, palynomorphs and radiolarians) in an effort to unravel the geodynamic evolution of an area thought to be located near the suture zone between the Tisza upper plate and the Adriatic lower plate, i.e. the Sava subduction zone of the Dinarides (e.g., Pamic, 2002; Schmid et al., 2008). The existence of this subduction zone was previously inferred here by local observations, such as metamorphosed Mesozoic sediments containing Middle Triassic conodonts (Đurđanović, 1971) or Early Cretaceous blue schists metamorphism (123±5 Ma, Milovanović et al., 1995). The metamorphic sequence is characterized by a Paleozoic age meta-sedimentary basement which contains palynomorphs of Upper Paleozoic - Carboniferous age and a meta-sedimentary and meta-volcanic sequence which contain a succession of contrasting metamorphosed lithologies such sandstones, black limestones, shallow water white limestones, basic volcanic sequences, deep nodular limestiones, radiolarites, meta-ophiolites and turbiditic sequences. The lower part of the sequence is contrastingly similar with the Triassic cover of the Drina-Ivanijca thrust sheet and its metamorphosed equivalent observed in the Kopaonik and Studenica series (Schefer et al., in press). This
Pressure-Temperature Studies and Structural Setting of Amphibolite-Grade Rocks Within the Easternmost Indus-Ysangpo Suture Zone and Forearc Complex (Tidding Formation), N. Indo-Burma Ranges of N.E. India
Braza, M.; Haproff, P. J.
The easternmost extension of the Indus-Ysangpo suture (IYS) and Xigaze forearc complex, the Tidding Formation of northeastern India, remains the least-studied sequence representing closure of the Neotethys ocean and syn-tectonic sedimentation. In this study, we present P-T determinations coupled with detrital zircon U-Pb geochronology and detailed geologic mapping to uncover the depositional and metamorphic history of Tidding suture and forearc rocks during Himalayan orogenesis. Four mica schists were sampled from successive NW-SE-striking thrust sheets within the Dibang Valley of Arunachal Pradesh (N.E. India), southwest of the easternmost L. Cretaceous Gangdese batholith. Use of the garnet-muscovite-biotite-plagioclase (GMBP) thermobarometer and Ti-in-biotite thermometer on schist sample PH-1-8-13-26 yield peak conditions of 627 ± 28°C and 10.4 ± 1.1 kbar. Similarly, use of the garnet-biotite Fe-Mg exchange thermometer and garnet-aluminosilicate-silica-plagioclase (GASP) barometer yield 644 ± 50°C and 12 ± 1 kbar for schist sample PH-11-14-15-24 within the same thrust sheet. Both samples contain recrystallized quartz along grain boundaries and garnets contain no significant compositional zoning. At structurally lower levels, garnet chlorite schist (PH-1-8-13-8) sampled from the Mayodia klippe records peak temperatures below 650°C. Garnets display growth zoning, with increasing Mn and decreasing Fe and Mg from rim to core. Application of the Ti-in-biotite thermometer to a mafic schist (PH-1-3-13-1B) within the Mayodia klippe near a southwestward-directed thrust yields a peak temperature of 679 ± 24°C. Our study reveals metamorphism of IYS rocks occurred at deep crustal levels (>30 km) during northward Neotethys subduction. Suture rocks were subsequently exhumed by orogen-scale N-dipping thrusts during growth of the easternmost Himalayan orogen.
Late Jurassic-Early Cretaceous radiolarian age constraints from the sedimentary cover of the Amasia ophiolite (NW Armenia), at the junction between the Izmir-Ankara-Erzinçan and Sevan-Hakari suture zones
Danelian, T.; Asatryan, G.; Galoyan, Gh.; Sahakyan, L.; Stepanyan, J.
The Amasia ophiolite, situated at the northernmost corner of Armenia, is part of the Sevan-Hakari suture zone which links with the Izmir-Ankara-Erzinçan suture zone in northern Turkey. Three new radiolarian assemblages have been extracted from siliceous sedimentary rocks that accumulated on the Amasia ophiolite in an oceanic setting. Two of these assemblages were extracted from red-brownish bedded cherts overlying basaltic lavas; one of these is likely to be middle Oxfordian to early Kimmeridgian in age, while the second correlates with the Berriasian. Similar time-equivalent lava-chert sequences have been dated recently using radiolarians from the Stepanavan, Vedi and Sevan ophiolite units, where they are considered to relate to submarine volcanic activity in the back-arc marginal basin in which the Armenian ophiolites were formed. The third radiolarian assemblage, of late Barremian age, was extracted from a more than 15-m-thick volcaniclastic-chert sequence. The related volcanic activity is likely to have been subaerial and probably relates to the formation of an oceanic volcanic plateau; no Cretaceous subaerial volcanism has been previously recorded in the Lesser Caucasus area.
Li, Yaning; Song, Juha; Ortiz, Christine; Boyce, Mary; Ortiz Group/DMSE/MIT Team; Boyce Group/ME/MIT Team
Biological sutures are joints which connect two stiff skeletal or skeletal-like components. These joints possess a wavy geometry with a thin organic layer providing adhesion. Examples of biological sutures include mammalian skulls, the pelvic assembly of the armored fish Gasterosteus aculeatus (the three-spined stickleback), and the suture joints in the shell of the red-eared slider turtle. Biological sutures allow for movement and compliance, control stress concentrations, transmit loads, reduce fatigue stress and absorb energy. In this investigation, the mechanics of the role of suture geometry in providing a naturally optimized joint is explored. In particular, analytical and numerical micromechanical models of the suture joint are constructed. The anisotropic mechanical stiffness and strength are studied as a function of suture wavelength, amplitude and the material properties of the skeletal and organic components, revealing key insights into the optimized nature of these ubiquitous natural joints.
Geological and Geophysical Integration Regarding a Structural Evolution Modelling of a Suture Zone Controlled by a Cratonic Buttress - The Case of Dom Feliciano Orogenic Belt, SSE Brazil, Implications for Western Gondwana Assembly
Bruno, H.; Almeida, J.; Heilbron, M. C. P. L.; Salomão, M.
The matters surrounding the amalgamation of tectonic blocks during the Brasiliano / Pan-African orogeny have been the main subject of study of several works in recent years. The main objective of this work is the hierarchy and discrimination of the boundaries between the known tectonic blocks, integrating geological and geophysical data. The geology of the study area is dominated by Precambrian terranes; Luís Alves Terrane, the vulcanosedimentary sequences of the Itajaí and Campo Alegre Basins, the metasedimentary sequences of the Brusque and Paranaguá Terranes and their granitic suites besides the granitoids of the Florianópolis Terrane. The shear zones and faults that separate these crustal blocks were developed during the Brasiliano / Pan-African orogenic cycle that led to the formation of the supercontinent Gondwana. These tectonic boundaries generally separate blocks of different rheology and crustal thickness. The integration of geological and geophysical data allowed the identification of important structural lineaments and crustal boundaries. The presented geodynamic model suggests that the suture between the block composed of the Brusque, Paranaguá and Florianópolis Terranes and the block composed by the Luís Alves Terrane is the Itajaí Perimbó Shear Zone, and not the Major Gercino Shear Zone as previously suggested. Considering the Itajaí Perimbó Shear Zone as the suture zone, the metassediments of the Brusque Terrane were deposited on the basement of the Florianópolis Terrane, hereby declared as part of the Angola Craton, and are correlated to the metassediments of the Paranaguá Terrane as a passive margin that in approximately ca. 650 My became active margin, functioning as a forearc basin. The oblique collision between the blocks would have occurred with the development of a dextral transpression in the Itajaí Perimbó Shear Zone, separating the Luís Alves Terrane from the Brusque Terrane, a sinistral transcurrence represented by the
Zeng, C.; Zhang, F.
Suspended sediment load of a river represents integrated results of soil erosion, ecosystem variation and landform change occurring within basin over a specified period. Accurate estimation of suspended sediment concentration is important for calculating suspended sediment load, therefore is helpful for evaluating the impact of natural and anthropogenic factors on earth system processes under the background of global climate change. However, long-term observation of suspended sediment concentration usually very difficult in harsh condition areas e.g. rivers on the Tibet Plateau. This study proposed two sediment rating curve subdivision methods, the flood rank method and suspended sediment concentration stages method, to improve the estimations of daily suspended sediment concentration of the Yarlung Zangbo river during 2007 to 2009. The flood rank method, hypothesized that the higher water flow with larger erosive power can mobilize sediment sources not available during lower flows, suitable for application where sediments were mainly transported by first few flood events. The suspended sediment concentration stages method, assumed that precipitation is the dominating driving force of sediment erosion and transport processes during the flooding periods, suitable for application where soil erosion was closely related to precipitation events. Compared to traditional sediment rating curve and subdivision methods, results showed that the proposed methods can improve suspended sediment concentration and subsequent suspended sediment load estimations in the middle reach of the Yarlung Zangbo river with higher coefficients of determination (R2) and Nash-Sutcliffe efficiency coefficients (NSE), and yielded smaller bias (BIAS) and root-mean-square errors (RMSE). This study can provide guidelines for regional ecological and environmental management.
Dragone, G. N.; Bologna, M.; Gimenez, M. E.; Alvarez, O.; Lince Klinger, F. G.; Correa-Otto, S.; Ussami, N.
The Paraná Magmatic Province (PMP) together with the Etendeka Province (EP) in Africa is one of the Earth's largest igneous provinces originated prior to the Western Gondwanaland break-up and the inception of the South Atlantic Ocean in the Lower Cretaceous. Geochemical data of PMP-EP basalts collected since late 1980's indicate the origin of PMP-EP by melting of a heterogeneous and enriched subcontinental lithospheric mantle with fast rate of eruption (< 3 My). The geodynamical cause of this magmatism is still a matter of debate (deep mantle plume x plate model). New isotopic geochemical data from Re-Os systematics (Rocha-Jr et al., 2012, EPSL) of PMP basalts indicate metasomatized asthenospheric mantle component probably generated at the mantle wedge between the PMP-EP lithosphere and the subducting oceanic plate. A combined seismic velocity and density model of PMP by Chaves et al. (2016, G3) indicates high velocity and a density increase of PMP ancient lithosphere interpreted as due to a long-term mantle refertilization process. To investigate the role of the subduction zones in the development of both the Paraná basin subsidence and the magmatic province we present the results of regional scale broad-band MT-magnetotelluric soundings across the western and southern borders of the PMP, the Western Paraná suture zone (WPS in Fig. 1). We discuss the electrical properties of the lithosphere along three MT profiles across the WPS. MT-A profile (Padilha et al., 2015, JGR) extends from Rio Apa craton towards the center of PMP (high-TiO2 basalts). Profile MT-B extends from Tebicuary craton towards the center of PMP (low-TiO2) and profile MT-C extends from Rio de la Plata craton towards the southern PMP (low- and high-TiO2). All profiles show a resistive ( 104 ohm m) and thick (> 150 km) lithosphere in the cratonic areas whereas the electrical lithosphere is thinner (<100 km) with alternating high and low resistivities within PMP. Vertically elongated and high
Xuan, Weidong; Xu, Yue-Ping
The Yarlung Zangbo River is located in southwest of China, one of the major source of "Asian water tower". The river has great hydropower potential and provides vital water resource for local and downstream agricultural production and livestock husbandry. Compared to its drainage area, gauge observation is sometimes not enough for good hydrological modeling in order to project future runoff. In this study, we employ a semi-distributed hydrologic model SWAT to simulate hydrological process of the river with rainfall observation and TRMM 3B4V7 respectively and the hydrological model performance is evaluated based on not only total runoff but snowmelt, precipitation and groundwater components. Firstly, calibration and validation of the hydrological model are executed to find behavioral parameter sets for both gauge observation and TRMM data respectively. Then, behavioral parameter sets with diverse efficiency coefficient (NS) values are selected and corresponding runoff components are analyzed. Robust parameter sets are further employed in SWAT coupled with CMIP5 GCMs to project future runoff. The final results show that precipitation is the dominating contributor nearly all year around, while snowmelt and groundwater are important in the summer and winter alternatively. Also sufficient robust parameter sets help reduce uncertainty in hydrological modeling. Finally, future possible runoff changes will have major consequences for water and flood security.
Deng, Mingfeng; Chen, Ningsheng; Ding, Haitao
The Parlung Zangbo Basin in the southeastern Tibet Plateau is affected by the summer monsoon from the Indian Ocean, which produces large rainfall gradients in the basin. Rainfall data during 2012-2015 from five new meteorological stations are used to analyse the rainfall characteristics. The daily rainfall, rainfall duration, mean rainfall intensity, and peak rainfall intensity are consistent, but sometimes contrasting. For example, these values decrease with increasing altitude, and the gradient is large downstream and small upstream, respectively. Moreover, the rainfall intensity peaks between 01:00 and 06:00 and increases during the afternoon. Based on the analysis of 14 debris flow cases in the basin, differences in the rainfall threshold differ depending on the location as sediment varieties. The sediment in the middle portions of the basin is wet and well structured; thus, long-duration, high-intensity rainfall is required to generate debris flows. Ravels in the upstream area are arid and not well structured, and short-duration rainfall is required to trigger debris flows. Between the above two locations, either long-duration, low-intensity rainfall or short-duration, high-intensity rainfall could provoke debris flows. Clearly, differences in rainfall characteristics and rainfall thresholds that are associated with the location must be considered in debris flow monitoring and warnings.
Campbell, C.; Taylor, M. H.; Licht, A.; Mueller, M.; Ocakglu, F.; Moeller, A.; Metais, G.; Beard, K. C.
Detrital zircons from a Cretaceous forearc basin and Tertiary foreland basin located along the Sakarya Zone of the Western Pontides were analyzed to better understand the closure history of the Tethyan oceans. The Variscan Orogeny is characterized by abundant 350-300 Ma U-Pb ages and vertical ɛHf arrays, consistent with a mature magmatic arc that emplaced plutons through a southward growing accretionary margin. An ɛHf pull-up is observed from 300-250 Ma interpreted as rifting of the Intra-Pontide Ocean. The Cimmerian Orogeny is characterized by a 250-230 Ma ɛHf pull-down, followed by a 230-200 Ma magmatic gap consistent with underthrusting of the Karakaya Complex. From 200-120 Ma another magmatic lull is observed. The Alpine Orogeny is characterized by an ɛHf pull-down from 120-85 Ma within Cretaceous forearc sediments and a 100 Ma deviant ɛHf vertical array within Tertiary foreland basin sediments. Minor zircon U-Pb age peaks and contrasting inter-basinal ɛHf evolution are interpreted to represent onset of Andean-style subduction along the southern margin of the Sakarya Zone at 120 Ma followed by crustal thickening until 85 Ma. The deviant 100 Ma ɛHf vertical array within foreland basin detritus is interpreted as initiation of intra-oceanic subduction within the Izmir-Ankara Ocean. An 85-75 Ma ɛHf pull-up from forearc basin sediments is interpreted as slab roll-back along the southern margin of the Sakarya Zone, responsible for final rifting of the Western Black Sea. At 80 Ma, a vertical ɛHf array from Tertiary foreland basin deposits is interpreted to represent synchronous melting of the Tavsanli Zone and intra-oceanic slab break-off. A single 66 Myr pre-collisional grain defines a sharp ɛHf pull-down immediately prior to total arc shut-off, interpreted to represent incipient collision between the Sakarya and Tavsanli zones. A 52 Ma syn-collisional tuff yields minimally intermediate ɛHf values followed by a slight 48 Ma ɛHf pull-down, interpreted as a
Xie, C.; Jin, S.; Wei, W.; Ye, G.; Fang, Y.; Zhang, L.; Dong, H.; Yin, Y.
The Tibetan plateau is the largest and most recent plateau orogenic belt in the world, and the south part is expected as the ongoing India-Eurasia continental collision zone. The collision-related deposit zones which are distributed in south plateau could be roughly divided into three parts: the porphyry deposit in the Gangdese magmatic belt, the chromite deposit along the Yarlung-Zangbo suture (YZS) and the prospective deposit along the gneiss domes in the Tethys Himalayan. The deep ore-controlling role of those deposit zones is still remain controversial. Previous magnetotelluric (MT) data deployed from Himalayan to Gangdese terrane were inverted using a three dimensional (3D) MT inversion algorithm ModEM. The results show that the resistivity cover layers above -10 km are distributed along the whole profiles, whereas small and sporadic conductors could be also imaged. The middle to lower crust beneath -25 km is imaged as large scale but discontinuous conductive zones which have a central resistivity less than 10 ohm·m. We suggest the middle to lower crustal conductors could be interpreted as partial melting. This hypothesis is supported by some previous geological and geochemical studies. The Metallogenesis and partial melting play an important role in promoting each other. For the metallogenesis, the high water content is one of the prominent factors, and could be released on breakdown of amphibole in eclogite and garnet amphibolite during melting. On the other hand, the increasing of the water content would probably advance partial melting. The results indicate that the deep process and magmatism beneath different deposit zones are probably varying. We studied the rheological characteristics from the perspective of subsurface electrical structures. We hope by comparative analysis, the process of `origins - migration -formation' for the system of deep `magma - rheology - deposition' would be better understood.
Zhao, Jie; Huang, Baochun; Yan, Yonggang; Zhang, Donghai
In order to better understand the paleogeographic position of the Baoshan Terrane in the northernmost part of the Sibumasu Block during formation of the Pangea supercontinent, a paleomagnetic study has been conducted on Late Triassic basaltic lavas from the southern part of the Baoshan Terrane in the West Yunnan region of Southwest China. Following detailed rock magnetic investigations and progressive thermal demagnetization, stable characteristic remanent magnetizations (ChRMs) were successfully isolated from Late Triassic Niuhetang lava flows. The ChRMs are of dual polarity and pass fold and reversal tests with magnetic carriers dominated by magnetite and subordinate oxidation-induced hematite; we thus interpret them as a primary remanence. This new paleomagnetic result indicates that the Baoshan Terrane was located at low paleolatitudes of ∼15°N in the Northern Hemisphere during Late Triassic times. Together with available paleomagnetic data from the Baoshan Terrane and surrounding areas, a wider paleomagnetic comparison supports the view that the East Paleotethys Ocean separated the Sibumasu and Indochina blocks and closed no later than Late Triassic times. We argue that the currently approximately north-to-south directed Changning-Menglian suture zone is very likely to have been oriented nearly east-to-west at the time of the Sibumasu-Indochina collision.
Gaber, Mohamed; Abdel-Wahed, Ramadan
This study aims to provide a helpful guide to perform tissue suturing successfully using suture coding-a method for identification of suture patterns and techniques by giving full information about the method of application of each pattern using numbers and symbols. Suture coding helps construct an infrastructure for surgical suture science. It facilitates the easy understanding and learning of suturing techniques and patterns as well as detects the relationship between the different patterns. Guide points are fixed on both edges of the wound to act as a guideline to help practice suture pattern techniques. The arrangement is fixed as 1-3-5-7 and a-c-e-g on one side (whether right or left) and as 2-4-6-8 and b-d-f-h on the other side. Needle placement must start from number 1 or letter "a" and continue to follow the code till the end of the stitching. Some rules are created to be adopted for the application of suture coding. A suture trainer containing guide points that simulate the coding process is used to facilitate the learning of the coding method. (120) Is the code of simple interrupted suture pattern; (ab210) is the code of vertical mattress suture pattern, and (013465)²/3 is the code of Cushing suture pattern. (0A1) Is suggested as a surgical suture language that gives the name and type of the suture pattern used to facilitate its identification. All suture patterns known in the world should start with (0), (A), or (1). There is a relationship between 2 or more surgical patterns according to their codes. It can be concluded that every suture pattern has its own code that helps in the identification of its type, structure, and method of application. Combination between numbers and symbols helps in the understanding of suture techniques easily without complication. There are specific relationships that can be identified between different suture patterns. Coding methods facilitate suture patterns learning process. The use of suture coding can be a good
Aktay, Sevima A; Kowaleski, Michael P
To compare mechanical performance of 2 orientations of the 5 mm Corkscrew® suture anchor with #5 Fiberwire® . In vitro biomechanical study. Suture anchor-suture constructs (n=40). Acute and cyclic tensile loads were applied to suture threaded through eyelets of 40 anchors perpendicular to the long axis of the anchor. Eyelets were positioned so that the suture pull was in line with (anchor rotation angle of 0° [ARA 0]) or 90° (ARA 90) to the eyelet plane. Load at failure, stiffness, and cycles to failure were determined. All constructs failed by suture breakage at the eyelet. Mean load at failure was significantly higher in the ARA 90 group (634 ± 93 N) compared with the ARA 0 group (495 ± 52 N; P=.0015). No significant difference was found between groups for mean number of cycles to failure (270 ± 177 versus 178 ± 109; P=.2166) and stiffness (50 ± 4 versus 48 ± 5 N/mm; P=.3141). The Corkscrew® 5 mm suture anchor with Fiberwire® suture fails via suture breakage at the eyelet under higher acute loads if the suture is loaded at an angle of 90° compared with 0° with respect to the plane of the eyelet. © Copyright 2011 by The American College of Veterinary Surgeons.
Ozkaptan, M.; Gulyuz, E.; Kaymakci, N.; Langereis, C. G.; Ozacar, A. A.; Lefebvre, C.
Two Neotethyan Sutures,Izmir-Ankara and Intra-Tauride suture zones meet around Ankara region appx. at right angles.The northerly located Izmir-Ankara Suture zone follows approximately E-W trend and it makes a sharp approximately 90° bend at the east along the western margin of the Çankiri Basin.The Intra-Tauride suture follows approximately the Tuzgölü Fault Zone and trends NW-SE and seems to be overprinted by the structures related to the Izmir-Ankara suture zone. These two sutures meet southeastern corner of the Haymana Basin where the basin makes major eastwards counterclockwise bend.From west to East, the Haymana, Tuzgölü and Çankiri Basins straddle these suture zones and are developed in relation to the subduction and collision processes in the region, making them the perfect sites to unravel deformation history and paleogeography of the Neotethyan suture zones in the region. In order to accomplish this, the tectono-stratigraphic evolution of the basin and its paleogeographical positions, in different time slices, constructed by conducting a very detailed study on the Late Cretaceous to Recent infill of the Haymana, Tuzgölü, and Çankiri Basins. We collected more than 4500 sedimentary paleomagnetic samples for paleomagnetic purposes from 112 different locations within 250 km diameter area.Before the demagnetization process, nearly 3000 core specimens were measured for anisotropy of magnetic susceptibility (AMS) in order to understand deformation amounts and kinematics.The paleomagnetic results show that the region underwent strong clockwise and counterclockwise rotations more than 90° in places, resulting in the present geometry of the suture zones. The central part of the Haymana basin rotated as high as 90° counterclockwise while its northern part together with the southwestern part of the Çankiri basin and northern part of the Tuzgölü basin rotated approximately 30° clockwise contrary to almost all published paleomagnetic data from the region
Alecu, L; Pascu, A; Costan, I; Deacu, A; Marin, A; Corodeanu, G; Gulinescu, L
Of this work was the study of using, as well as the utility of the mechanical sutures in colorectal surgery; because of the special caution needed to be taken for any colonic or rectal suture, more than any other digestive segment. The frequency of the postoperative fistulas after the suture and anastomosis is higher at this level and so it increases the period and costs of the hospitalization. We studied the possibilities of performing and evolution of 64 mechanical sutures for 19 patients, with colorectal pathology, hospitalized in our department from july 1999 to december 2000. We performed 64 mechanical sutures, as followed: 47 in open surgery and 17 in laparoscopic. From all these, 56 was bowel sutures, 8 of them were vascular (in laparoscopic, for cutting the most important vascular pedicles). We did 18 anastomosis: 15 in open and 3 in laparoscopic surgery. It was 2 postoperative fistulas from all 56 intestinal sutures (3.57%). We haven't any intra or postoperative bleeding from the vascular anastomosis. It was 3 intraoperative bleeding from the intestinal anastomosis, and only 1 case of postoperative bleeding (5.26% of the cases: 1.56% of all mechanical sutures). In only one case, the mechanical suture couldn't be initially done, but it succeeded after the removing of the segment of the bowel involved. Mechanical sutures offers a high level of safety to the colorectal anastomosis. It provides a very good vascularization to the anastomosis and decreases the time needed for performing the suture or anastomosis, versus manual sature. Also, for the patients with rectal ampular neoplasm, it creates the possibility of anal sphincter preservation by making a low colorectal anastomoses--which is difficult by manual suture.
Robinson, James R; Frank, Evelyn G; Hunter, Alan J; Jermin, Paul J; Gill, Harinderjit S
A simple suture technique in transosseous meniscal root repair can provide equivalent resistance to cyclic load and is less technically demanding to perform compared with more complex suture configurations, yet maximum yield loads are lower. Various suture materials have been investigated for repair, but it is currently not clear which material is optimal in terms of repair strength. Meniscal root anatomy is also complex; consisting of the ligamentous mid-substance (root ligament), the transition zone between the meniscal body and root ligament; the relationship between suture location and maximum failure load has not been investigated in a simulated surgical repair. (A) Using a knottable, 2-mm-wide, ultra-high-molecular-weight polyethylene (UHMWPE) braided tape for transosseous meniscal root repair with a simple suture technique will give rise to a higher maximum failure load than a repair made using No. 2 UHMWPE standard suture material for simple suture repair. (B) Suture position is an important factor in determining the maximum failure load. Controlled laboratory study. In part A, the posterior root attachment of the medial meniscus was divided in 19 porcine knees. The tibias were potted, and repair of the medial meniscus posterior root was performed. A suture-passing device was used to place 2 simple sutures into the posterior root of the medial meniscus during a repair procedure that closely replicated single-tunnel, transosseous surgical repair commonly used in clinical practice. Ten tibias were randomized to repair with No. 2 suture (Suture group) and 9 tibias to repair with 2-mm-wide knottable braided tape (Tape group). The repair strength was assessed by maximum failure load measured by use of a materials testing machine. Micro-computed tomography (CT) scans were obtained to assess suture positions within the meniscus. The wide range of maximum failure load appeared related to suture position. In part B, 10 additional porcine knees were prepared. Five
Pu, X.; An, R.; Li, R.; Huang, W.; Li, J.
The objectives of the current study are to investigate the spatial, temperal variation of phisphorus (P) fraction in middle reaches of the Yarlung Zangbo River of China. Samples were collected in April (dry season), August (wet season), and Octber (normal season) along with the middle reaches from Lazi site to Nuxia sitewhich which is about 1000km long. Sequential extraction were applied to determine the forms of phosphorus in suspended particles and to assess the potential bioavailability of particulate P. The results indicated that the distribution of suspended particle size inflenced not only the total phosphorus concentration, but also the proportions of different forms of phosphorus. The exchangeable phosphorus (Ex-P), Fe-bound-P, Ca-bound-P were the most aboundant forms and the highest proportions of total P. The total P concentrations were closely relative to the concentration of suspended particles. According to the characteristics of suspended particles in the Yarlung Zangbo River, the relationship between the suspended particles size and species of phosphorus was established though statistical analysis. The Ex-P increased with the decreasing of suspended particulate size. The content of bioavailable particulate phosphorus varied greatly with the proportions of particulate size. In genral, the higher the proportion of smaller particle size, the higher the content of bioavailable phosphorus. The main factors which affect the phosphorus transportation in Yarlung Zangbo River had also been discussed.
Gil, Joseph A; Skjong, Christian; Katarincic, Julia A; Got, Christopher
To assess the strength of flexor tendon repair with looped suture. We hypothesized that, after passing the intact looped suture in the desired repair configuration, splitting the loop and tying 2 independent knots would increase the strength of flexor tendon repair. Thirty-two flexor tendons were harvested and were sharply transected in zone II. The tendons were repaired with a 4-strand core suture repair using 3-0 looped nonabsorbable nylon suture. The harvested tendons were randomly assigned and repaired with either a 1- or a 2-knot construct. The repaired flexor tendons were fixed in a servohydraulic material testing system and were loaded to failure either with uniaxial tension or cyclically. The average force at failure was 43 N for the 1-knot repair and 28 N for the 2-knot repair. The mode of failure of 15 of the flexor tendon repairs that were cyclically loaded to failure was suture pull-out. The average number of cycles and force in cyclic testing that caused failure of flexor tendon repairs was 134 cycles and 31 N for tendons repaired with looped 3-0 suture tied with 1 knot and 94 cycles and 33 N for tendons repaired with looped 3-0 suture tied with 2 knots. Our hypothesis was disproved by the results of this study. This study suggests that, when using looped suture, tying 2 independent knots instead of tying a single knot does not increase the strength of the flexor tendon repair. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Sachan, Himanshu Kumar; Kharya, Aditya; Singh, P. Chandra; Rolfo, Franco; Groppo, Chiara; Tiwari, Sameer K.
The best occurrence of blueschist-facies lithologies in Himalaya is that of the Shergol Ophiolitic Mélange along the Indus suture zone in Ladakh region of north-western India. These lithologies are characterized by well preserved lawsonite-glaucophane-garnet-quartz assemblages. This paper presents for the first time the results of a detailed fluid inclusion study on these lithologies, in order to understand the fluid P-T evolution and its tectonic implications. The blueschist rocks from Shergol Ophiolitic Mélange record metamorphic peak conditions at ∼19 kbar, 470 °C. Several types of fluid inclusions are trapped in quartz and garnet, most of them being two-phase at room temperature. Three types of fluid inclusions have been recognised, basing on microtextures and fluid composition: Type-I are primary two-phase carbonic-aqueous fluid inclusions (VCO2 - LH2O); Type-II are two-phase (LH2O - VH2O) aqueous fluid inclusions, either primary (Type-IIa) or secondary (Type-IIb); Type-III are re-equilibrated fluid inclusions. In the Type-I primary carbonic-aqueous inclusions, H2O is strongly predominant with respect to CO2; the homogenization temperature of CO2 range from -7 to -2 °C. The clathrate melting temperature in such inclusions varies in between +7.1 and +8.6 °C. Type-II two-phase aqueous fluid inclusions show a wide range of salinity, from 7.8-14 wt.% NaCleq (Type-IIa) to 1.65-6.37 wt.% NaCleq (Type-IIb) with accuracy ±0.4 wt.% NaCleq. Type-I and Type-IIa primary fluid inclusions are hosted in peak minerals (garnet and quartz included in garnet), therefore they were likely entrapped at, or near to, peak P-T conditions. The dominantly aqueous fluid of both Type-I and Type-IIa inclusions was most likely produced through metamorphic devolatilization reactions occurring in the subducting slab. Despite their primary nature, the isochores of Type-I and Type-IIa inclusions do not intersect the peak metamorphic conditions of the blueschist mineral assemblage
Rhodes, Jennifer L.; Tye, Gary W.; Fearon, Jeffrey A.
Craniosynostosis affecting the lambdoid suture is uncommon. The definition of lambdoid craniosynostosis solely applies to those cases demonstrating true suture obliteration, similar to other forms of craniosynostosis. In patients presenting with posterior plagiocephaly, true lambdoid craniosynostosis must be differentiated from the much more common positional molding. It can occur in a unilateral form, a bilateral form, or as part of a complex craniosynostosis. In children with craniofacial syndromes, synostosis of the lambdoid suture most often is seen within the context of a pansynostotic picture. Chiari malformations are commonly seen in multisutural and syndromic types of craniosynostosis that affect the lambdoid sutures. Posterior cranial vault remodeling is recommended to provide adequate intracranial volume to allow for brain growth and to normalize the skull shape. Although many techniques have been described for the correction of lambdoid synostosis, optimal outcomes may result from those techniques based on the concept of occipital advancement. PMID:25210507
Rhodes, Jennifer L; Tye, Gary W; Fearon, Jeffrey A
Craniosynostosis affecting the lambdoid suture is uncommon. The definition of lambdoid craniosynostosis solely applies to those cases demonstrating true suture obliteration, similar to other forms of craniosynostosis. In patients presenting with posterior plagiocephaly, true lambdoid craniosynostosis must be differentiated from the much more common positional molding. It can occur in a unilateral form, a bilateral form, or as part of a complex craniosynostosis. In children with craniofacial syndromes, synostosis of the lambdoid suture most often is seen within the context of a pansynostotic picture. Chiari malformations are commonly seen in multisutural and syndromic types of craniosynostosis that affect the lambdoid sutures. Posterior cranial vault remodeling is recommended to provide adequate intracranial volume to allow for brain growth and to normalize the skull shape. Although many techniques have been described for the correction of lambdoid synostosis, optimal outcomes may result from those techniques based on the concept of occipital advancement.
Ruff, Gregory L
Ligatures have been used for millennia to close wounds. Sterilization and synthetic polymers that degrade in a commensurate fashion with wound healing have been the most significant improvements in these age-old devices. However, the constricting loop of a traditional suture and subsequent ischemia ("approximate, don't strangulate") still account for the most common cause of wound dehiscence-necrosis. Inspired by the quill of the North American porcupine, I envisioned a bidirectional array of barbs that could secure tissue without relying on constricting loops. One set of barbs could anchor the other. In this article, I document the development process of these barbed sutures from concept to patent to manufacture and US Food and Drug Administration approval. Knotless, strong, and easy to place, barbed sutures could foreseeably supplant conventional sutures, particularly as endoscopic procedures become more common. They also offer the intriguing potential to suspend ptotic tissues without surgical intervention.
LIU, X.; Xu, Z.; Peng, D.
Vegetation growth plays a significant role on runoff variation at high altitude, and precipitation and temperature are both key factors affecting vegetation conditions. As one of the greatest international rivers in China, the Yarlung Zangbo River in the southern Qinghai-Tibetan Plateau was selected, and the spatio-temporal patterns of vegetation were analyzed by using NDVI (Normalized Difference Vegetation Index) during 1998 2014. The relationship between NDVI and precipitation as well as temperature was also investigated in this study. Results showed that the value of NDVI increases with the decrease of elevation and the largest value appears in the broadleaf forest cover. Almost all annual NDVI variations exhibit an increasing tendency, particularly for the broadleaf forest cover. On the viewpoint of statistics, only 29% pixels of NDVI with increasing tendency are of significance for the other cover, while for cultivated vegetation cover, around 82% pixels of NDVI were detected with significant increasing tendency. In addition, vegetation growth showed lagging response to precipitation, and the lag time is around one month. Moreover, in the region with elevation over 5000 m, negative relationship between NDVI and precipitation for alpine vegetation was found. Approximately 75% of NDVI variations are dominated by precipitation and temperature. These findings may provide a reference to investigate runoff variations and strengthen ecological protection for similar high-altitude areas in the future.
The demonstration that the Kapuskasing structure involves substantial thrusting of deep continental crustal rocks over shallower continental rocks calls into question an earlier suggestion (by Wilson) that the Circum-Ungaua suture zone continued through the Kapuskasing to join the Penokean fold belt (implying that the Kapuskasing marked the site of what has since come to be called a cryptic suture). Problems are discussed which arose in attempting to reconcile Wilson's idea with data from more recent studies: whether the Kapuskasing and the Thompson belt both mark sutures of about 1700 Ma age; why there is no age difference across the Kapuskasing if it does mark the site of continental collision, and why there is no offset of Superior subprovinces across the Kapuskasing.
Guyuron, Bahman; Wang, Derek Z; Kurlander, David E
Costal cartilage graft warping can challenge rhinoplasty surgeons and compromise outcomes. We propose a technique, the "warp control suture," for eliminating cartilage warp and examine outcomes in a pilot group. The warp control suture is performed in the following manner: Harvested cartilage is cut to the desired shape and immersed in saline to induce warping. A 4-0 or 5-0 PDS suture, depending the thickness of the cartilage, is passed from convex to concave then concave to convex side several times about 5-6 mm apart, finally tying the suture on the convex side with sufficient tension to straighten the cartilage. First an ex vivo experiment was performed in 10 specimens from 10 different patients. Excess cartilage was sutured and returned to saline for a minimum of 15 min and then assessed for warping compared to cartilage cut in the identical shape also soaked in saline. Then, charts of nine subsequent patients who received the warp control suture on 16 cartilage grafts by the senior author (BG) were retrospectively reviewed. Inclusion of study subjects required at least 6 months of follow-up with standard rhinoplasty photographs. Postoperative complications and evidence of warping were recorded. In the ex vivo experiment, none of the 10 segments demonstrated warping after replacement in saline, whereas all the matching segments demonstrated significant additional warping. Clinically, no postoperative warping was observed in any of the nine patients at least 6 months postoperatively. One case of minor infection was observed in an area away from the graft and treated with antibiotics. No warping or other complications were noted. The warp control suture technique presented here effectively straightens warped cartilage graft and prevents additional warping. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online
Winkel, R; Kalbhenn, O; Hoffmann, R
This retrospective examination compares the results of finger flexor tendon sutures with 2 strands and 4 strands. It was checked, whether and how 2 more strands influenced the rupture rate, the movement of the finger and the contentment of the patients. From 1996 to 2000 for the core suture of the flexor tendon of fingers we used 2 strands. 35 patients with 40 tendon sutures of 73 patients were examined. From 2001 to 2005 we used for the core suture 2 loop threads. 53 patients with 64 tendon sutures from a total of 111 patients were examined. At least 12 months had passed between operation and the examination. The rupture rate and the range of movement of each finger joint and the total mobility of the affected fingers were evaluated. Each case was compared to the uninjured opposite hand. The functional result was judged according to the score of Buck-Gramcko. The patient's contentment was recorded by the DASH (disability of arm, shoulder and hand) score. Effects of gender, age, accompanying injuries, zone of the injury and their influence on the results were analysed. The Buck-Gramcko score showed in the 2-strand group a distribution from summarised 70% "excellent" and "good" and 30% "fair" and "poor". In the 4-strand-group the relation was 93.7% "excellent" and "good", 6.3% "fair", one "poor". In the 2-strand group 2/40 (5%) of the tendon sutures ruptured, in the 4-strand group 1/64 (1.6%) ruptured. The average DASH value in the 2-strands-group was 16.6/100, in the 4-strands-group 18.1/100 when 0 is the best possible result and 100 the worst. The patient judgement in the 2-strand group was summarised to 70% for "excellent" and "good" and 30% "fair" and "poor". In the 4-strand group the patient's judgment was summarised in 75% "excellent" and "good" and in 25% "fair". The results of flexor tendon sutures with 4-strand core sutures have been superior to the results with 2-strand core suture according to range of motion of the fingers (P <0.005). © Georg Thieme
Bagheri, S.; Stampfli, G. M.
The Triassic rocks of the Nakhlak area have been used to justify the hypothesis of the rotation of the Central-East Iranian microplate, mainly based on paleomagnetic data. Davoudzadeh and his coworkers (1981) pointed out the existing contrast between the Nakhlakh succession and the time-equivalent lithostratigraphic units exposed in the surrounding regions and compared them with the Triassic rocks of the Aghdarband area on the southern edge of the Turan plate. We recently gathered evidences that this part of central Iran effectively belongs to the Northern Iranian Paleo-Tethys suture zone and related Variscan terrains of the Turan plate. This is the case for the northwestern part of central Iran, where the Anarak-Khur belt (Anarak schists and their thick Cretaceous-Paleocene sedimentary cover) presents all the elements of an orogenic zone such as dismembered ophiolites and silisiclastics, calcareous and volcanic cover which has been deformed and metamorphosed. This belt is separated to the northwest from the Alborz microcontinent by the Great Kavir fault and Cretaceous ophiolite mélanges. To the southeast it is bounded by the Biabanak fault and serpentinites and the Biabanak block, part of the central-east Iranian plate. The later zone is formed by Proterozoic metamorphic basement and marine sedimentary cover, nearly continuous from the Ordovician to the Triassic, at the uppermost part upper Triassic-lower Jurassic bauxites and silisiclastics are observed. Excepted the Ordovician angular unconformities and the boundary between lower Jurassic and younger layers, this sequence displays no significant main unconformities and can be attributed to the Cimmerian super-terrain. Thus, this sequences represents the classical evolution of the southern Paleo-Tethys passive margin, as found in the Alborz microcontinent or the Band-e Bayan zone of Afghanistan and is the witness of large scale duplication of the Paleo-Tethys suture zone through major Alpine strike-slip faults
Walsh, Susanna S
Materials management personnel at a health care facility in Baltimore, Maryland, were stocking too much suture. They stocked suture requested by surgeons or recommended by suture company representatives, and, because the facility is a teaching institution, they stocked suture requested by residents. No master suture database was available to determine what was needed and what was not. As a result, some suture was rarely used, which cost the facility money and took up inventory space. In response, I created a list of the existing inventory and coordinated with the specialty surgical service coordinators to determine which suture was typically used and in what quantities. I used this information to create a master list, with the goal of eliminating the purchase of suture that was not on this list. I gave the staff members and surgeons two months to assess the list and determine whether the suggested suture was sufficient for their needs. I then asked the materials management personnel to order and maintain suture stock based on the master list. This process took approximately four months and shows how health care providers can take a high-volume item, such as suture, and create cost-saving processes that will serve surgeons' and patients' needs while reducing costs and streamlining stock. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.
Vogt, P M; Altintas, M A; Radtke, C; Meyer-Marcotty, M
If pharmaceutic modulation of scar formation does not improve the quality of the healing process over conventional healing, the surgeon must rely on personal skill and experience. Therefore a profound knowledge of wound healing based on experimental and clinical studies supplemented by postsurgical means of scar management and basic techniques of planning incisions, careful tissue handling, and thorough knowledge of suturing remain the most important ways to avoid abnormal scarring. This review summarizes the current experimental and clinical bases of surgical scar management.
Devinck, F; Riot, S; Qassemyar, A; Belkhou, A; Wolber, A; Martinot Duquennoy, V; Guerreschi, P
Cleft palate requires surgery in the first years of life, furthermore repairing anatomically the soft and hard palate is complex on a surgical level because of the fine tissues and the local intraoral configuration. It is valuable to train first on simulators before going to the operating room. However, there is no material dedicated to learning how to perform intraoral sutures in cleft palate surgery. We made one, in an artisanal manner, in order to practice before the real surgical gesture. The simulator was designed based on precise anatomical data. A steel pipe, fixed on a rigid base represented the oral cavity. An adapted split spoon represented the palate. All pieces could be removed in order to apply a hydrocellular dressing before training for sutures. Our simulator was tested by 3 senior surgeons in our department in close to real-life conditions in order to evaluate its anatomical accuracy. It is valuable to have a simulator to train on cleft palate sutures within teaching university hospitals that manage this pathology. Our simulator has a very low cost, it is easy to make and is anatomically accurate. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Storch, Mark; Scalzo, Howard; Van Lue, Stephen; Jacinto, Gabriel
The goal of this study was to compare the physical and functional properties of coated polyglactin 910 suture with and without triclosan by human assessment and instrument-based measurements. Surgeons specializing in general, orthopedic, plastic, or gynecologic surgery evaluated the suture materials in an in vivo porcine model with regard to (1) ease of passage through tissue, (2) first-throw knot holding, (3) knot tie-down smoothness, (4) knot security, (5) surgical handling, and (6) overall evaluation. Breaking strength retention was determined at 14, 21, 28, and 35 days post-implantation in rats using a tensile strength measurement device. The absorption rate was determined in rats by histopathology at 7, 28, 56, 63, 70, and 77 days post-implantation. The tactile smoothness and tie-down behavior of both wet and dry sutures were evaluated by product characterization technicians. The scores for surgeons' evaluation of suture material were favorable and similar for both sutures. Surgeons could not reliably make a distinction in handling between the two sutures. Breaking strength retention was the same for both sutures, ranging from 79% on day 14 to 5% on day 35. Both sutures were essentially absorbed at 70 days post-implantation. Product characterization assessment of the two sutures found them to be indistinguishable. The addition of triclosan to coated polyglactin 910 sutures did not affect physical handling properties or performance characteristics based on the testing and evaluations performed.
Connolly, Karen L; Albertini, John G; Miller, Christopher J; Ozog, David M
The Frost suture is a well-known surgical technique for providing upward tension on the lower lid to prevent or correct ectropion after surgical interventions in the periorbital area. Despite its relatively common use, comprehensive information on executing this technique is not readily available. To review eyelid anatomy, indications, and proper technique for performing the Frost suture, as well as potential complications. A review of the literature on Frost sutures was performed. Cadaveric dissection was performed to demonstrate placement of the Frost suture. The Frost suture is a useful method to reduce the risk of ectropion after surgery near the lower eyelid. Downward pull on the lid can occur with normal wound contracture even if ectropion is not present with the initial repair, reinforcing the need for preventive measures. Potential complications of this technique include superficial skin erosion of the upper lid, corneal abrasion, and blockage of the field of vision while the suture is in place.
Cho, Byung-Ki; Kim, Yong-Min; Kim, Dong-Soo; Choi, Eui-Sung; Shon, Hyun-Chul; Park, Kyoung-Jin
This prospective, randomized study was conducted to compare clinical outcomes of the modified Broström procedure using suture anchor or transosseous suture technique for chronic ankle instability. Forty patients were followed for more than 2 years after modified Broström procedure. Twenty procedures using a suture anchor and 20 procedures using a transosseous suture were performed by one surgeon. The clinical evaluation consisted of the Karlsson scale and the Sefton grading system. Talar tilt and anterior talar translation were measured on anterior and varus stress radiographs. The Karlsson scale had improved significantly to 90.8 points in the suture anchor group, and to 89.2 points in the transosseous suture group. According to Sefton grading system, 18 patients (90%) in suture anchor group and 17 patients (85%) in transosseous suture group achieved satisfactory results. The talar tilt angle and anterior talar translation improved significantly to 5.9 degrees and 4.2 mm in suture anchor group, and to 5.4 degrees and 4.1 mm in transosseous suture group, respectively. No significant differences existed in clinical and functional outcomes between the two techniques for ligament reattachment. Both modified Broström procedures using the suture anchor and transosseous suture seem to be effective treatment methods for chronic lateral ankle instability.
Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; von Deimling, Constantin; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias
Background Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. Objectives This study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure. Methods As a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups. Results Zone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on
Obermeier, Andreas; Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; Deimling, Constantin von; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias; Burgkart, Rainer; von Eisenhart-Rothe, Rüdiger
Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. This study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure. As a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups. Zone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on coated sutures with higher roughness for
Andrtová, M; Chlupatá, I
The authors discuss problems of rehabilitation after suture of the anterior cruciate ligament where frequently errors are committed and where inadequate rehabilitation may cause damage to the patient. Different periods of rehabilitation after LCA sutures are discussed and suitable methods of exercise for different periods are recommended.
Javalgi, Anita P; Arakeri, Surekha U
There are known post thyroidectomized complications, a suture granuloma being less frequent, with its late complication mimicking recurrent thyroid cancer. A suture granuloma is a benign, granulomatous inflammatory reaction that occurs due to the use of non absorbable suture. It constitutes one of the late complications which altogether make up less than 2% of its incidence. A suture granuloma is similar to a foreign body reaction and it usually develops slowly as a painless, palpable asymptomatic mass over the years. It mimics a cancer recurrence or a lymph node metastasis. Here, we are reporting a case of a post thyroidectomy suture granuloma in a 46 years old lady who presented with a painless swelling in the lateral neck, with a past history of thyroidectomy 5 years back.
Javalgi, Anita P.; Arakeri, Surekha U.
There are known post thyroidectomized complications, a suture granuloma being less frequent, with its late complication mimicking recurrent thyroid cancer. A suture granuloma is a benign, granulomatous inflammatory reaction that occurs due to the use of non absorbable suture. It constitutes one of the late complications which altogether make up less than 2% of its incidence. A suture granuloma is similar to a foreign body reaction and it usually develops slowly as a painless, palpable asymptomatic mass over the years. It mimics a cancer recurrence or a lymph node metastasis. Here, we are reporting a case of a post thyroidectomy suture granuloma in a 46 years old lady who presented with a painless swelling in the lateral neck, with a past history of thyroidectomy 5 years back. PMID:23730655
Ozkaptan, M.; Gulyuz, E.; Kaymakci, N.; Langereis, C. G.
The consumption of the Neo-Tethyan Ocean and the accretion of intervening continental blocks such as the Taurides and Kırşehir Block in the south and the Pontides in the north since the Mesozoic occurred along two sutures. The İzmir-Ankara Suture Zone (IASZ) between the Pontides in the north and the Taurides in the south and Intra-Tauride suture Zone (ITSZ) between the Taurides and the Kırşehir block meets around the Haymana Basin. The IASZ follows roughly an E-W trend and makes a sharp bend of approximately of 90° along the western margin of the Çankırı Basin. The ITSZ, on the other hand, follows a NW-SE trend parallel to the Tuz Gölü Fault Zone and overprinted by the structures related to the İASZ in the north. From West to East; the Haymana, Tuz Gölü and Çankırı basins straddle these suture zones and are developed in relation to the subduction and collision processes, which make them invaluable for unraveling deformation history and evolution of the Neotethys. In this regard we have conducted a very detailed paleomagnetic study to determine vertical axis rotations in the region, mainly on the Late Cretaceous to Recent infill of these basins. Results have shown that the region undergone strong clockwise (CW) and counter-clockwise (CCW) rotations, up to ±90° in places, resulting in the present geometry of the region. The central part of the Haymana Basin rotated as much as 90° CCW sense while its northern parts and the Tuz Gölü basin rotated 30° CW sense, which contradicts with almost all the published paleomagnetic results from the region. The restored geometries, based on new paleomagnetic data indicate that Haymana, Tuz Gölü basins and the SW margin of the Çankırı Basin were initially oriented in N-S direction prior to the Eocene. These results indicate that the most of the paleogeographical maps and evolutionary scenarios and models proposed for the region previously requires major re-thinking and serious revisions.
Cheregi, Cornel Dragos; Simon, Ioan; Fabian, Ovidiu; Maghiar, Adrian
Colorectal cancer is one of the most frequent digestive malignancies, being the third cause of death by cancer, despite early diagnosis and therapeutic progress made over the past years. Standard treatment in these patients is to preserve the anal sphincter with restoration of intestinal function by mechanical colorectal anastomosis or coloanal anastomosis, and to maintain genitourinary function by preservation of hypogastric nerves. In order to emphasize the importance of this surgical technique in the Fourth Surgical Clinic of the CF Clinical Hospital Cluj-Napoca, we conducted a prospective observational interventional study over a 3-year period (2013-2016) in 165 patients hospitalized for rectal and rectosigmoid adenocarcinoma in various disease stages, who underwent Dixon surgery using the two techniques of manual and mechanical end-to-end anastomosis. For mechanical anastomosis, we used Covidien and Panther circular staplers. The patients were assigned to two groups, group A in which Dixon surgery with manual end-to-end anastomosis was performed (116 patients), and group B in which Dixon surgery with mechanical end-to-end anastomosis was carried out (49 patients). Mechanical anastomosis allowed to restore intestinal continuity following low anterior resection in 21 patients with lower rectal adenocarcinoma compared to 2 patients in whom intestinal continuity was restored by manual anastomosis, with a statistically significant difference (p<0.000001). The double-row mechanical suture technique is associated with a reduced duration of surgery (121.67 minutes for Dixon surgery with mechanical anastomosis, compared to 165.931 minutes for Dixon surgery with manual anastomosis, p<0.0001). The use of circular transanal staplers facilitates end-to-end anastomosis by double-row mechanical suture, allowing to perform low anterior resection in situations when the restoration of intestinal continuity by manual anastomosis is technically not possible, with the aim to
CHEREGI, CORNEL DRAGOS; SIMON, IOAN; FABIAN, OVIDIU; MAGHIAR, ADRIAN
Background and aims Colorectal cancer is one of the most frequent digestive malignancies, being the third cause of death by cancer, despite early diagnosis and therapeutic progress made over the past years. Standard treatment in these patients is to preserve the anal sphincter with restoration of intestinal function by mechanical colorectal anastomosis or coloanal anastomosis, and to maintain genitourinary function by preservation of hypogastric nerves. Methods In order to emphasize the importance of this surgical technique in the Fourth Surgical Clinic of the CF Clinical Hospital Cluj-Napoca, we conducted a prospective observational interventional study over a 3-year period (2013–2016) in 165 patients hospitalized for rectal and rectosigmoid adenocarcinoma in various disease stages, who underwent Dixon surgery using the two techniques of manual and mechanical end-to-end anastomosis. For mechanical anastomosis, we used Covidien and Panther circular staplers. The patients were assigned to two groups, group A in which Dixon surgery with manual end-to-end anastomosis was performed (116 patients), and group B in which Dixon surgery with mechanical end-to-end anastomosis was carried out (49 patients). Results Mechanical anastomosis allowed to restore intestinal continuity following low anterior resection in 21 patients with lower rectal adenocarcinoma compared to 2 patients in whom intestinal continuity was restored by manual anastomosis, with a statistically significant difference (p<0.000001). The double-row mechanical suture technique is associated with a reduced duration of surgery (121.67 minutes for Dixon surgery with mechanical anastomosis, compared to 165.931 minutes for Dixon surgery with manual anastomosis, p<0.0001). Conclusion The use of circular transanal staplers facilitates end-to-end anastomosis by double-row mechanical suture, allowing to perform low anterior resection in situations when the restoration of intestinal continuity by manual anastomosis
Betz, C; Schleicher, P; Winkel, R; Hoffmann, R
In this study we examined the tensile strength of core sutures of tendons. In particular, we examined the effect of having 2 or 4 stitch strands in the core suture as well as the effect of additional locking sutures on the tensile strength. 60 flexor tendons from the forepaws of freshly slaughtered swines were harvested for biomechanical testing. They were divided into 4 groups (A, B, C and D) of 15 sutures each. Group A: core suture after Zechner with 2 strands; group B: modified core suture with 4 strands; group C: modified core suture with 2 strands and 4 locking sutures; group D: modified core suture with 4 strands and 4 locking sutures. The primary tensile strength of the sutures was measured in Newton using the testing machine with a traction speed of 0.1 mm/s. Simultaneously, the increasing space forming at the suture was filmed against graph paper. Our command variables were force measured in Newton when forming a space of 2 mm as well as the force at which the suture failed. Statistical analysis was carried out with the software SPSS to produce a multivariate analysis with a statistical significance of p<0.05. Results are presented as averages including the 1st and 3rd quartile (1Q/3Q). Under traction to form a 2 mm space, the force measured with group A was 14.2 N (12.9/15.1 N). In group B the force 22.5 N (20.0/24.7 N) was significantly higher (p<0.05). Group C required a traction force of 28.7 N (23.5/35.8 N) which was significantly higher than for groups A and B. Group D required the significantly highest traction force of 42.0 N (39.5/46.0 N) to produce a 2 mm space. The force required for the suture to fail in group A was 19.9 N (17.9/22.8 N), in group B: 26.2 N (24.5/29.7 N), in group C 32.0 N (27.1/40.1 N) and in Group D 46.5 N (41.5/50.0 N); the differences between the gloups were all statistically significant. The primary tensile strength of core sutures after Zechner on flexor tendons from the forepaws of swines was significantly increased by
Okubo, Hirotaka; Kusano, Nozomu; Kinjo, Masaki; Kanaya, Fuminori
In multi-strand suture methods consisting of several suture rows, the different length of core suture purchase between each suture row may affect the strength of repairs. We evaluated the influence of the different length of core suture purchase between each suture row on the strength of 6-strand tendon repairs. Rabbit flexor tendons were repaired by using a triple-looped suture technique in which the suture purchase length in each suture row was modified. Group 1, all lengths are 8-mm. Group 2, all lengths are 10-mm. Group 3, two are 10-mm and one is 8-mm. Group 4, one is 10-mm and two are 8-mm. The repaired tendons were subjected to load-to-failure test. The gap strength was significantly greater in Group 1 and Group 2 than in Group 3 and Group 4. This study demonstrates that maintaining equal core suture purchase lengths of each suture row increases the gap resistance.
Whinnett, Alaine; Zimmermann, Marie; Willmott, Keith R; Herrera, Nimiadina; Mallarino, Ricardo; Simpson, Fraser; Joron, Mathieu; Lamas, Gerardo; Mallet, James
‘Suture zones’ are areas where hybrid and contact zones of multiple taxa are clustered. Such zones have been regarded as strong evidence for allopatric divergence by proponents of the Pleistocene forest refugia theory, a vicariance hypothesis frequently used to explain diversification in the Amazon basin. A central prediction of the refugia and other vicariance theories is that the taxa should have a common history so that divergence times should be coincident among taxa. A suture zone for Ithomiinae butterflies near Tarapoto, NE Peru, was therefore studied to examine divergence times of taxa in contact across the zone. We sequenced 1619 bp of the mitochondrial COI/COII region in 172 individuals of 31 species from across the suture zone. Inferred divergence times differed remarkably, with divergence between some pairs of widespread species (each of which may have two or more subspecies interacting in the zone, as in the genus Melinaea) being considerably less than that between hybridizing subspecies in other genera (for instance in Oleria). Our data therefore strongly refute a simple hypothesis of simultaneous vicariance and suggest that ongoing parapatric or other modes of differentiation in continuous forest may be important in driving diversification in Amazonia. PMID:16271979
Hayeri, Mohammad Reza; Keefe, Daniel T; Chang, Eric Y
Rotator cuff repair using a suture bridge and knotless suture anchors is a relatively new, but increasingly used technique. The suture bridge technique creates an anatomically similar and more secure rotator cuff repair compared with conventional arthroscopic techniques and the use of knotless anchors eliminates the challenges associated with knot tying during arthroscopic surgery. However, previous in vitro biomechanical tests have shown that the hold of the suture in a knotless suture anchor is far lower than the pullout strength of the anchor from bone. Up until now slippage has been a theoretical concern. We present a prospectively diagnosed case of in vivo suture loosening after rotator cuff repair using a knotless bridge technique resulting in subacromial-subdeltoid bursitis.
Kronberger, L; Germann, R
A general inquiry was made at surgical units and university clinics in Austria about the anastomosis techniques used between 1980 to 1985. The result was that in 90.3% the suture was made by hand and in 9.7% by machine. The first mentioned was performed as double row inverting suture by 66% of our surgeons, and only in 30% as an all-layer suture. The stapler-technique was mostly preferred for the oesophago-jejunostomy and the high and lower resection of the rectum. A leakage of the suture line was observed in 3.9% after sewing by hand and in 6.3% after stapling. The total lethality finally was 1.4% for hand made suture and 1.8% for apparative suture.
Linderman, Stephen W.; Kormpakis, Ioannis; Gelberman, Richard H.; Birman, Victor; Wegst, Ulrike G. K.; Genin, Guy M.; Thomopoulos, Stavros
Suture materials and surgical knot tying techniques have improved dramatically since their first use over five millennia ago. However, the approach remains limited by the ability of the suture to transfer load to tissue at suture anchor points. Here, we predict that adhesive-coated sutures can improve mechanical load transfer beyond the range of performance of existing suture methods, thereby strengthening repairs and decreasing the risk of failure. The mechanical properties of suitable adhesives were identified using a shear lag model. Examination of the design space for an optimal adhesive demonstrated requirements for strong adhesion and low stiffness to maximize the strength of the adhesive-coated suture repair construct. To experimentally assess the model, we evaluated single strands of sutures coated with highly flexible cyanoacrylates (Loctite 4903 and 4902), cyanoacrylate (Loctite QuickTite Instant Adhesive Gel), rubber cement, rubber/gasket adhesive (1300 Scotch-Weld Neoprene High Performance Rubber & Gasket Adhesive), an albumin-glutaraldehyde adhesive (BioGlue), or poly(dopamine). As a clinically relevant proof-of-concept, cyanoacrylate-coated sutures were then used to perform a clinically relevant flexor digitorum tendon repair in cadaver tissue. The repair performed with adhesive-coated suture had significantly higher strength compared to the standard repair without adhesive. Notably, cyanoacrylate provides strong adhesion with high stiffness and brittle behavior, and is therefore not an ideal adhesive for enhancing suture repair. Nevertheless, the improvement in repair properties in a clinically relevant setting, even using a non-ideal adhesive, demonstrates the potential for the proposed approach to improve outcomes for treatments requiring suture fixation. Further study is necessary to develop a strongly adherent, compliant adhesive within the optimal design space described by the model. PMID:26022966
Braid, James A.; Murphy, J. Brendan; Quesada, Cecilio; Gladney, Evan R.; Dupuis, Nicolle
Magmatic activity is an integral component of orogenic processes, from arc magmatism during convergence to post-collisional crustal melting. Southern Iberia exposes a Late Paleozoic suture zone within Pangea and where a crustal fragment of Laurussia (South Portuguese Zone) is juxtaposed with parautochthonous Gondwana (Ossa Morena Zone). Fault-bounded oceanic metasedimentary rocks, mélanges and ophiolite complexes characterize the suture zone and are intruded by plutonic rocks and mafic dykes. The generation and emplacement of these intrusive rocks and their relationship to development of the suture zone and the orogen are undetermined. Field evidence combined with U/Pb (zircon) geochronology reveals three main phases of plutonism, a pre-collisional unfoliated gabbroic phase emplaced at ca 354 Ma, crosscut by a syn-tectonic ca 345 Ma foliated granodiorite phase followed by a ca 335 Ma granitic phase. Geochemical analyses (major, trace, rare earth elements) indicate that the gabbro exhibits a calc-alkaline arc signature whereas the granodiorite and granite are typical of post-collisional slab break-off. Taken together, these data demonstrate a protracted development of the orogen and support a complex late stage evolution broadly similar to the tectonics of the modern eastern Mediterranean. In this scenario, the highly oblique closure of a small tract of oceanic lithosphere postdates the main collision event resulting in escape of parautochthonous and allochthonous terranes toward the re-entrant.
Muffly, Tyler M; Tizzano, Anthony P; Walters, Mark D
Summary The purpose of the study is to review the history and innovations of sutures used in pelvic surgery. Based on a review of the literature using electronic- and hand-searched databases we identified appropriate articles and gynaecology surgical textbooks regarding suture for wound closure. The first documented uses of suture are explored and then the article focuses on the use of knotted materials in pelvic surgery. The development of suture of natural materials is followed chronologically until the present time where synthetic suture is implanted during countless surgeries every day. This millennial history of suture contains an appreciation of the early work of Susruta, Celsus, Paré and Lister, including a survey of some significant developments of suture methods over the last 100 years. Most surgeons know little about the history and science of sutures. A retrospective view of suture is critical to the appreciation of the current work and development of this common tool. PMID:21357979
Muffly, Tyler M; Tizzano, Anthony P; Walters, Mark D
The purpose of the study is to review the history and innovations of sutures used in pelvic surgery. Based on a review of the literature using electronic- and hand-searched databases we identified appropriate articles and gynaecology surgical textbooks regarding suture for wound closure. The first documented uses of suture are explored and then the article focuses on the use of knotted materials in pelvic surgery. The development of suture of natural materials is followed chronologically until the present time where synthetic suture is implanted during countless surgeries every day. This millennial history of suture contains an appreciation of the early work of Susruta, Celsus, Paré and Lister, including a survey of some significant developments of suture methods over the last 100 years. Most surgeons know little about the history and science of sutures. A retrospective view of suture is critical to the appreciation of the current work and development of this common tool.
Li, Chunyan; Tang, Ya; Luo, Han; Di, Baofeng; Zhang, Liyun
Climate change affects the productivity of agricultural ecosystems. Farmers cope with climate change based on their perceptions of changing climate patterns. Using a case study from the Middle Yarlung Zangbo River Valley, we present a new research framework that uses questionnaire and interview methods to compare local farmers' perceptions of climate change with the adaptive farming strategies they adopt. Most farmers in the valley believed that temperatures had increased in the last 30 years but did not note any changes in precipitation. Most farmers also reported sowing and harvesting hulless barley 10-15 days earlier than they were 20 years ago. In addition, farmers observed that plants were flowering and river ice was melting earlier in the season, but they did not perceive changes in plant germination, herbaceous vegetation growth, or other spring seasonal events. Most farmers noticed an extended fall season signified by delays in the freezing of rivers and an extended growing season for grassland vegetation. The study results showed that agricultural practices in the study area are still traditional; that is, local farmers' perceptions of climate change and their strategies to mitigate its impacts were based on indigenous knowledge and their own experiences. Adaptive strategies included adjusting planting and harvesting dates, changing crop species, and improving irrigation infrastructure. However, the farmers' decisions could not be fully attributed to their concerns about climate change. Local farming systems exhibit high adaptability to climate variability. Additionally, off-farm income has reduced the dependence of the farmers on agriculture, and an agricultural subsidy from the Chinese Central Government has mitigated the farmers' vulnerability. Nevertheless, it remains necessary for local farmers to build a system of adaptive climate change strategies that combines traditional experience and indigenous knowledge with scientific research and government
Li, Chunyan; Tang, Ya; Luo, Han; Di, Baofeng; Zhang, Liyun
Climate change affects the productivity of agricultural ecosystems. Farmers cope with climate change based on their perceptions of changing climate patterns. Using a case study from the Middle Yarlung Zangbo River Valley, we present a new research framework that uses questionnaire and interview methods to compare local farmers' perceptions of climate change with the adaptive farming strategies they adopt. Most farmers in the valley believed that temperatures had increased in the last 30 years but did not note any changes in precipitation. Most farmers also reported sowing and harvesting hulless barley 10-15 days earlier than they were 20 years ago. In addition, farmers observed that plants were flowering and river ice was melting earlier in the season, but they did not perceive changes in plant germination, herbaceous vegetation growth, or other spring seasonal events. Most farmers noticed an extended fall season signified by delays in the freezing of rivers and an extended growing season for grassland vegetation. The study results showed that agricultural practices in the study area are still traditional; that is, local farmers' perceptions of climate change and their strategies to mitigate its impacts were based on indigenous knowledge and their own experiences. Adaptive strategies included adjusting planting and harvesting dates, changing crop species, and improving irrigation infrastructure. However, the farmers' decisions could not be fully attributed to their concerns about climate change. Local farming systems exhibit high adaptability to climate variability. Additionally, off-farm income has reduced the dependence of the farmers on agriculture, and an agricultural subsidy from the Chinese Central Government has mitigated the farmers' vulnerability. Nevertheless, it remains necessary for local farmers to build a system of adaptive climate change strategies that combines traditional experience and indigenous knowledge with scientific research and
Soylu, Selen; Teksoz, Serkan; Ozcan, Murat; Bukey, Yusuf
Silk suture reaction (i.e., a benign granulomatous inflammatory foreign body reaction) is a rare complication of thyroid surgery. Here, two cases of post-thyroidectomy suture reaction are presented. Both of the patients were female, one is 48 and the other is 34 years old. The patients were presented with neck swelling and leakage of serous fluid from the Kocher’s incision. Both patients had normal free T4, free T3, and TSH values. The 48-year-old female patient had a right subtotal and left near-total thyroidectomy 6 years ago and the other had bilateral total thyroidectomy 6 years ago. In the physical examination a mobile, painless, red, swelling was palpated in front of neck. In the ultrasound of both patients, a heterogeneous nodule with hypoechoic rim was seen, however, in scintigraphy no radiopharmaceutical involvement was observed in thyroid region. Due to suspicion of thyroid malignancy, a fine needle aspiration biopsy was performed and foreign body reaction was revealed cytologically. A suture reaction can vary from an erythematous swelling to chronic granulomatous reaction. The time interval between the operation and formation of suture reaction was 6 years in both of the cases thus these patients were considered as chronic patients. Foreign body reaction diagnosis was confirmed with fine needle aspiration biopsy. It is important to diagnose these chronic inflammation cases since these cases can mimic recurrence in thyroid malignancies. A post-thyroidectomy suture reaction is diagnosed cytologically with fine needle aspiration biopsy and by surgical removal of suture, this chronic inflammatory reaction can be cured. PMID:29142853
Deters, Katherine A.; Brown, Richard S.; Boyd, James W.
The size reduction of acoustic transmitters has led to a reduction in the length of incision needed to implant a transmitter. Smaller suture knot profiles and fewer sutures may be adequate for closing an incision used to surgically implant an acoustic microtransmitter. As a result, faster surgery times and reduced tissue trauma could lead to increased survival and decreased infection for implanted fish. The objective of this study was to assess the effects of five suturing techniques on mortality, tag and suture retention, incision openness, ulceration, and redness in juvenile Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Suturing wasmore » performed by three surgeons, and study fish were held at two water temperatures (12°C and 17°C). Mortality was low and tag retention was high for all treatments on all examination days (7, 14, 21, and 28 days post-surgery). Because there was surgeon variation in suture retention among treatments, further analyses included only the one surgeon who received feedback training in all suturing techniques. Incision openness and tissue redness did not differ among treatments. The only difference observed among treatments was in tissue ulceration. Incisions closed with a horizontal mattress pattern had more ulceration than other treatments among fish held for 28 days at 17°C. Results from this study suggest that one simple interrupted 1 × 1 × 1 × 1 suture is adequate for closing incisions on fish under most circumstances. However, in dynamic environments, two simple interrupted 1 × 1 × 1 × 1 sutures should provide adequate incision closure. Reducing bias in survival and behavior tagging studies is important when making comparisons to the migrating salmon population. Therefore, by minimizing the effects of tagging on juvenile salmon (reduced tissue trauma and reduced surgery time), researchers can more accurately estimate survival and behavior.« less
Coats, D K
Adjustable sutures in strabismus surgery may be difficult or impossible in poorly cooperative patients. An adjunct suture technique that allows a 1-step, all-or-nothing, preprogrammed adjustment in patients not considered good candidates for standard postoperative adjustable sutures is described. Twelve patients underwent adjustable strabismus surgery using the ripcord technique. Six patients had unacceptable alignment after surgery. In 5 of these, alignment was successfully adjusted. The ripcord adjustable suture technique is effective and is well tolerated by patients.
Greenberg, James A; Clark, Rachel M
Despite millennia of experience with wound closure biomaterials, no study or surgeon has yet identified the perfect suture for all situations. Tissue characteristics, tensile strength, reactivity, absorption rates, and handling properties should be taken into account when selecting a wound closure suture. This review discusses the wound healing process and the biomechanical properties of currently available suture materials to better understand how to choose suture material in obstetrics and gynecology. PMID:19826572
Egbert, G. D.
Magnetotellurics (MT) provides a powerful geophysical tool for imaging of ancient suture zones, which are frequently marked by elongated zones of very low resistivity. These conductive anomalies, which can extend to great depths and have apparently persisted for several billion years, most likely result from graphite and sulfides deeply emplaced and remobilized, through subduction, accretion and orogenesis. The Earthscope MT transportable array provides a unique broad-scale view of sutures in the continental US. In the northwestern US subvertical conductive features bound all of the major cratonic blocks. These can be identified with the Cheyenne Belt between the Wyoming Craton (WC) and Yavapai Terranes (YT), the Great Falls Tectonic Zone between WC and the Medicine Hat Block (MHB), and the Vulcan Structure of southern Alberta between MHB and the Hearne Craton. In all cases the conductive anomalies extend well into the mantle lithosphere. The more recent MT TA footprint in the north-central US (surrounding the Mid-Continent Rift (MCR)) also reveals conductive signatures of ancient sutures. The most prominent lies south of Lake Superior, just north of the Niagara Fault (NF), and can be associated with the Penokean Orogeny (~1.85 Ga). A second, further south beneath Iowa and western Wisconsin, just south of the Spirit Lake tectonic zone (SLtz), can be identified with YT accretion (~1.75 Ga). Both of these sutures are cleanly cut by the MCR. The break in the anomalies is narrow (comparable to the surface expression of the MCR) indicating that rifting impacts on the entire crustal section were highly localized. The south-dipping NF conductive anomaly extends from surface outcrop to at least the Moho. The SLtz anomaly is north-dipping, extending from mid-crust through the Moho. In both cases there is some evidence for a modestly conductive layer (likely carbon) thrust to mid-lithospheric depths within the overriding terrane.
The teaching of practical skills such as venepuncture and suturing are important for medical students and junior doctors alike. Despite its importance, little time is devoted to its teaching on the undergraduate curriculum. Instead, the responsibility of skills teaching often falls to senior health care professionals. At Aberdeen Royal Infirmary, clinicians have laid on 'after-work' skills workshops. One of the regularly run workshops is on basic suturing. Initially these sessions were run in a relatively ad-libbed and unprepared way. It was clear that these sessions were not as successful as they could be--with students failing to attain proficiency at the desired rate. It was decided to adapt the suturing workshop by adhering to current theories in modern educational practice. Using the work of Gagné and others, small changes were made to the delivery of the workshop to see if this improved student outcome. Adapting the workshops using modern educational theory had two distinct benefits: the students enjoyed the sessions far more and attained proficiency in suturing more quickly. The article demonstrates how making small changes, which are not labour intensive, can dramatically improve the impact of a teaching session. © Blackwell Publishing Ltd 2012.
was surrounded, in the area of the suture, by abundantly developed cicatrical tissue and was tightly adhered to the surrounding tissue. When there...later, the vascular cicatrix represents solid cicatrical tissue, and, on the side of the vascular lumen, is covered with endothelim, Silk threads were
Ishiyama, Yasuhiro; Inaki, Noriyuki; Bando, Hiroyuki; Yamada, Tetsuji
The aim of this study is to assess the difficulty of intracorporeal suturing in single-port surgery, using experimental suturing model in dry box. Subjects were divided for three groups: seven experienced laparoscopic surgeons, seven surgical residents, and seven interns. An experimental suturing model is developed, and working angle was set from 0° to 90°. The completion rate in 0° was significantly lower than that in the other angles. Completion rate of group A was higher than that of the other groups. Precision of task in group A was significantly higher than that of group B and group C in 0° and 60°. Stress score in 0° were significantly higher than that in the other angles. Our study demonstrated that intracorporeal suturing in single-port surgery seems to be more difficult than conventional laparoscopic surgery. Our data should be taken the institution under consideration for introduction of single-port surgery.
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Endovascular Suturing System. 870.3460 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3460 Endovascular Suturing System. (a) Identification. An endovascular suturing system is a medical device intended to provide...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Endovascular Suturing System. 870.3460 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3460 Endovascular Suturing System. (a) Identification. An endovascular suturing system is a medical device intended to provide...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Endovascular Suturing System. 870.3460 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3460 Endovascular Suturing System. (a) Identification. An endovascular suturing system is a medical device intended to provide...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... surgical gut suture. (a) Identification. An absorbable surgical gut suture, both plain and chromic, is an...
Topczewska, Jolanta M.; Shoela, Ramy A.; Tomaszewski, Joanna P.; Mirmira, Rupa B.; Gosain, Arun K.
Using morphological, histological, and TEM analyses of the cranium, we provide a detailed description of bone and suture growth in zebrafish. Based on expression patterns and localization, we identified osteoblasts at different degrees of maturation. Our data confirm that, unlike in humans, zebrafish cranial sutures maintain lifelong patency to sustain skull growth. The cranial vault develops in a coordinated manner resulting in a structure that protects the brain. The zebrafish cranial roof parallels that of higher vertebrates and contains five major bones: one pair of frontal bones, one pair of parietal bones, and the supraoccipital bone. Parietal and frontal bones are formed by intramembranous ossification within a layer of mesenchyme positioned between the dermal mesenchyme and meninges surrounding the brain. The supraoccipital bone has an endochondral origin. Cranial bones are separated by connective tissue with a distinctive architecture of osteogenic cells and collagen fibrils. Here we show RNA in situ hybridization for col1a1a, col2a1a, col10a1, bglap/osteocalcin, fgfr1a, fgfr1b, fgfr2, fgfr3, foxq1, twist2, twist3, runx2a, runx2b, sp7/osterix, and spp1/ osteopontin, indicating that the expression of genes involved in suture development in mammals is preserved in zebrafish. We also present methods for examining the cranium and its sutures, which permit the study of the mechanisms involved in suture patency as well as their pathological obliteration. The model we develop has implications for the study of human disorders, including craniosynostosis, which affects 1 in 2,500 live births. PMID:27829009
Wongkietkachorn, Apinut; Rhunsiri, Peera; Boonyawong, Pangpoom; Lawanprasert, Attaporn; Tantiphlachiva, Kasaya
Tutoring in suturing was developed to compensate for a shortage of suturing cases. The objective of this study was to compare ideal suturing score (ISS; 9 points), suturing time (min:sec), and suture placement error (mm) between medical students completing the suturing tutoring program and medical students attending ordinary medical school training program. Participants consisted of 2 groups of medical students who had never performed suturing. The study group had the role of suturing tutor to teach interested high school students. The control group consisted of volunteers from the ordinary medical school program. Skills measurement was performed by having students from both the groups perform 3 vertical mattress sutures on a model. The study group was tested at weeks 1, 9, and 10 to assess improvement. Both the groups were tested at week 10 to compare final learning outcome. There were 41 and 40 participants in the study group and the control group, respectively. ISS was significantly improved in the study group from week 1-week 10 (7.0 ± 1.3 vs. 8.2 ± 0.9, p = 0.01). At week 10, the study group had a higher mean ISS than the control group (8.2 ± 0.9 vs. 7.8 ± 1.1, p = 0.68). Mean suturing time and mean placement error were also lower in the study group at the end of suturing training (5:1 ± 1:0 vs. 5:2 ± 1:2, p = 0.13; 7.4 ± 7.4 vs. 8.0 ± 10.8, p = 0.44). Tutoring trainees to suture can improve a student's ability to learn how to suture. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Custis, Trenton; Armstrong, April W.; King, Thomas H.; Sharon, Victoria R.; Eisen, Daniel B.
IMPORTANCE Although applying adhesive strips to a wound closure has been shown to have outcomes equivalent to those with cuticular suturing, it is unknown whether adhesive strips provide additional benefit compared with dermal suturing alone. OBJECTIVE To determine whether the addition of adhesive strips to a wound closed with buried interrupted subcuticular sutures improves outcomes following wound closure. DESIGN, SETTING, AND PARTICIPANTS A prospective, randomized split-wound intervention was conducted between November 14, 2013, and May 16, 2014, in patients who underwent cutaneous surgical procedures at the University of California, Davis, outpatient dermatology clinic. Fifty-seven patients 18 years or older with postoperative defects of at least 3 cm, resulting from either Mohs micrographic surgical procedures or surgical excision, were screened for participation. Nine patients were excluded and 48 were enrolled. INTERVENTIONS Half of each wound was randomized to receive buried interrupted subcuticular sutures and overlying adhesive strips and the other half received buried interrupted subcuticular sutures only. MAIN OUTCOMES AND MEASURES At 3 months’ follow-up, each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale. RESULTS The total mean (SD) Patient Observer Scar Assessment Scale score for observers for the side that received a combination of adhesive strips and buried interrupted subcuticular suturing (12.3 [4.8]) and the side that received sutures only (12.9 [6.3]) did not differ significantly at 3 months (P = .32). There was no significant difference in the total patient assessment scale score between the combination closure (14.0 [7.6]) and sutures only (14.7 [7.6]) sides at 3 months (P = .39). There was also no significant difference between the 2 closure methods in terms of mean (SD) scar width (both methods: 1.1 [0.8] mm, P = .89) at follow-up. CONCLUSIONS AND RELEVANCE Combination closure with
Faria, Mun Y; Ferreira, Nuno P; Canastro, Mario
Subluxated or malpositioned intraocular lenses (IOLs) and inadequate capsular support is a challenge for every ophthalmic surgeon. Iris suture of an IOL seems to be an easy technique for the management of dislocated 3-piece IOL, allowing the IOL to be placed behind the iris, far from the trabecular meshwork and corneal endothelium. The purpose of this study is to assess the results of pars plana vitrectomy (PPV) and iris suture of dislocated 3-piece acrylic IOLs. In this retrospective, nonrandomized, interventional case consecutive study, of a total of 103 dislocated IOLs, 36 eyes were considered for analysis. All 36 eyes had subluxated or totally luxated 3-piece IOL and underwent iris suture at the Ophthalmology Department of Santa Maria Hospital-North Lisbon Hospital Center, Portugal, from January 2011 until November 2015. All patients underwent 3-port 23-G PPV. The optic zone of the dislocated IOL was placed anterior to the iris with the haptics behind, in the posterior chamber. Haptics were sutured to iris followed by placement of the optics behind iris plane. Postoperative measures included best-corrected visual acuity (BCVA), IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and development of macular edema. A total of 36 eyes of 36 patients were included. All underwent successful iris fixation of dislocated 3-piece IOL. Mean overall follow-up was 15.9 months (range 3-58 months). At presentation, 16 eyes (44.4%) had a luxated IOL and 20 eyes (55.6%) a subluxated IOL. As underlying cause, 17 eyes (47.2%) had a history of complicated cataract surgery, 5 eyes (13.9%) had a traumatic dislocation of the IOL, and 6 eyes (16.7%) had a previous vitreoretinal surgery. A total of 8 eyes (22.2%) had late spontaneous IOL dislocation after uneventful cataract surgery. The mean preoperative BCVA was 1.09 ± 0.70 logarithm of the minimal angle of resolution (logMAR) units and mean postoperative BCVA was 0.48 ± 0.58 of log
Regula, Christie G; Yag-Howard, Cyndi
There are an increasing number of wound closure materials and suturing techniques described in the dermatologic and surgery literature. A dermatologic surgeon's familiarity with these materials and techniques is important to supplement his or her already established practices and improve surgical outcomes. To perform a thorough literature review of wound closure materials (sutures, tissue adhesives, surgical tape, and staples) and suturing techniques and to outline how and when to use them. A literature review was conducted using PubMed and other online search engines. Keywords searched included suture, tissue adhesive, tissue glue, surgical tape, staples, dermatologic suturing, and suturing techniques. Numerous articles outline the utility of various sutures, surgical adhesives, surgical tape, and staples in dermatologic surgery. In addition, there are various articles describing classic and novel suturing techniques along with their specific uses in cutaneous surgery. Numerous factors must be considered when choosing a wound closure material and suturing technique. These include wound tension, desire for wound edge eversion/inversion, desired hemostasis, repair type, patient's ability to care for the wound and return for suture removal, skin integrity, and wound location. Careful consideration of these factors and proper execution of suturing techniques can lead to excellent cosmetic results.
Champeau, Mathilde; Thomassin, Jean-Michel; Tassaing, Thierry; Jérôme, Christine
Drug-eluting sutures represent the next generation of surgical sutures since they fulfill their mechanical functions but also deliver the drug in their vicinity after implantation. These implants are produced by a variety of manufacturing processes. Drug-eluting sutures represent the next generation of surgical sutures since they fulfill their mechanical functions but also deliver the drug in their vicinity after implantation. These implants are produced by a variety of manufacturing processes. Two general approaches can be followed: (i) the ones that add the API into the material during the manufacturing process of the suture and (ii) the ones that load the API to an already manufactured suture. Areas covered: This review provides an overview of the current manufacturing processes for drug-eluting suture production and discusses their benefits and drawbacks depending on the type of drugs. The mechanical properties and the drug delivery profile of drug-eluting sutures are highlighted since these implants must fulfill both criteria. Expert opinion: For limited drug contents, melt extrusion and electrospinning are the emerging processes since the drug is added during the suture manufacture process. Advantageously, the drug release profile can be tuned by controlling the processing parameters specific to each process and the composition of the drug-containing polymer. If high drug content is targeted, the coating or grafting of a drug layer on a pre-manufactured suture allows for preservation of the tensile strength requirements of the suture.
Chacon, Anna H; Shiman, Michael I; Strozier, Narissa; Zaiac, Martin N
Using the combination of a horizontal running mattress suture with intermittent loops achieves both good eversion with the horizontal running mattress plus the ease of removal of the simple loops. This combination technique also avoids the characteristic railroad track marks that result from prolonged non-absorbable suture retention. The unique feature of our technique is the incorporation of one simple running suture after every two runs of the horizontal running mattress suture. To demonstrate its utility, we used the suturing technique on several patients and analyzed the cosmetic outcome with post-operative photographs in comparison to other suturing techniques. In summary, the combination of running horizontal mattress suture with simple intermittent loops demonstrates functional and cosmetic benefits that can be readily taught, comprehended, and employed, leading to desirable aesthetic results and wound edge eversion. PMID:23723610
Mori, Hirohito; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Rafiq, Kazi; Oryu, Makoto; Fujiwara, Masao; Suzuki, Yasuyuki; Masaki, Tsutomu
Endoscopic full-thickness resection (EFTR) requires a reliable full-thickness suturing device and an endoscopic counter-traction device to prevent the collapse of the digestive tract. The present study aimed to assess the reliability of newly developed flexible endoscopy suturing devices and the feasibility of pure EFTR. A total of 30 EFTRs were performed and allocated to three groups (N = 10 for each group). The full-thickness sutures were placed using over-the-scope clips (OTSCs), hand-sewn sutures, or the Double-arm-bar Suturing System (DBSS). Air leak tests were conducted in the three groups. The times required for the placement of one OTSC suture and single-stitch simple interrupted sutures (hand-sewn and DBSS sutures, respectively) were also compared. All 30 full-thickness sutures were completely and successfully placed. Regarding the air leak tests, the Mann-Whitney U test showed significant differences between OTSC and hand-sewn sutures (p = 0.003). There was also a significant difference between OTSC and DBSS sutures (p = 0.023). There was no significant difference between hand-sewn and DBSS sutures (p = 0.542). A significant difference was found in the suture time for single-stitch simple interrupted sutures among the OTSC, hand-sewn, and DBSS sutures. The Mann-Whitney U test revealed a significant difference between OTSC and hand-sewn sutures (p = 0.0001). There was no significant difference between OTSC and DBSS sutures (p = 0.533), while a significant difference was found between hand-sewn and DBSS sutures (p = 0.0001). Pure EFTR is feasible if the mechanical counter traction system is used to expand a small operative field and DBSS is used to make full-thickness sutures. The high safety of full-thickness resection and full-thickness suturing allows for clinical applications of this method.
Albino, Frank P; Wood, Benjamin C; Oluigbo, Chima O; Lee, Angela C; Oh, Albert K; Rogers, Gary F
Genetic mutations in the fibroblast growth factor receptor 3 gene may lead to achondroplasia or syndromic forms of craniosynostosis. Despite sharing a common genetic basis, craniosynostosis has rarely been described in cases of confirmed achondroplasia. We report an infant with achondroplasia who developed progressive multiple-suture craniosynostosis to discuss the genetic link between these clinical entities and to describe the technical challenges associated with the operative management.
Rodriguez, Brian D.; Sampson, Jay A.
It is important to understand whether major mining districts in north-central Nevada are underlain by Archean crust, known to contain major orogenic gold deposits, or, alternatively, by accreted crust of the Paleoproterozoic Mojave province. Determining the location and orientation of the Archean-Proterozoic suture zone between the Archean crust and Mojave province is also critical because it may influence subsequent patterns of sedimentation, deformation, magmatism, and hydrothermal activity. In the Great Basin, the attitude of the suture zone is unknown because it is concealed below cover. A regional magnetotelluric sounding profile along the Utah-Nevada State line reveals a deeply penetrating, broad electrical conductor that may be the Archean-Proterozoic suture zone in the northwest corner of Utah. This major crustal conductor's strike direction is northwest, where it broadens to about 80 km wide below about 3-km depth. These results suggest that the southwestern limit of intact Archean crust in this part of the Great Basin is farther north than previously reported. These results also suggest that the major gold belts in north-central Nevada are located over the Paleoproterozoic Mojave province, and the Archean terrain lies northeast in the northwest corner of Utah. Rifted Archean crust segments south and west of the suture suggest that future mineral exploration northeast of current mineral trends may yield additional gold deposits.
Smith, Jesse M; Erlanger, Michael; Olson, Jeffrey L
We describe a surgical technique for scleral fixation of a posterior chamber intraocular lens (PC IOL) using a 24-gauge injectable polypropylene suture delivery system. A 3-piece PC IOL is inserted into the anterior chamber of the eye. Two sclerotomies are made 1.5 mm posterior to the limbus using a microvitreoretinal blade. The 24-gauge injector delivers a preformed suture loop into the eye with the double-armed needles still external to the eye. Each polypropylene IOL haptic is directed through the loop using microforceps. The suture loop is tightened around the haptic, and the attached needles are used to fixate the IOL to the sclera and close the sclerotomies simultaneously. This technique has been used in an ex vivo porcine eye and in an aphakic patient. In the latter, the IOL was quickly fixated to the sclera and maintained a stable position postoperatively. Dr. Olson has a patent pending for the device described in this article. No other author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Cray, James; Mooney, Mark P; Siegel, Michael I
Research on cranial suture biology suggests there is biological and taxonomic information to be garnered from the heritable pattern of suture synostosis. Suture synostosis along with brain growth patterns, diet, and biomechanical forces influence phenotypic variability in cranial vault morphology. This study was designed to determine the pattern of ectocranial suture synostosis in skeletal populations from the Aleutian Islands. We address the hypothesis that ectocranial suture synostosis pattern will differ according to cranial vault shape. Ales Hrdlicka identified two phenotypes in remains excavated from the Aleutian Island. The Paleo-Aleutians, exhibiting a dolichocranic phenotype with little prognathism linked to artifacts distinguished from later inhabitants, Aleutians, who exhibited a brachycranic phenotype with a greater amount of prognathism. A total of 212 crania representing Paleo-Aleuts and Aleutian as defined by Hrdlicka were investigated for suture synostosis pattern following standard methodologies. Comparisons were performed using Guttmann analyses. Results revealed similar suture fusion patterns for the Paleo-Aleut and Aleutian, a strong anterior to posterior pattern of suture fusion for the lateral-anterior suture sites, and a pattern of early termination at the sagittal suture sites for the vault. These patterns were found to differ from that reported in the literature. Because these two populations with distinct cranial shapes exhibit similar patterns of suture synostosis it appears pattern is independent of cranial shape in these populations of Homo sapiens. These findings suggest that suture fusion patterns may be population dependent and that a standardized methodology, using suture fusion to determine age-at-death, may not be applicable to all populations. Copyright © 2011 Wiley-Liss, Inc.
Kudva, Adarsh; Kamath, Abhay; Cariappa, K M; Gadicherla, Srikanth; Dhara, B Vasantha
An ectropion is a complication that can arise from reconstruction in the infraorbital region. Often, this complication occurs despite proper positioning of the lower lid at the time of closure. Various transcutaneous approaches to orbit skeleton have investigated in view of complication arising from them. A subtarsal approach with a postoperative Frost suture gives an advantage to reduce the occurrence of ectropion especially after treatment of orbital floor fractures. This case describes a method of subcuticular suturing technique for subtarsal incision of lower lid which can be used to support the lid during healing period, thus decreasing the rate of ectropion. The technique described here is an alterative method for frost suturing with certain advantages.
Botden, S M B I; de Hingh, I H J T; Jakimowicz, J J
Providing informative feedback and setting goals tends to motivate trainees to practice more extensively. Augmented Reality simulators retain the benefit of realistic haptic feedback and additionally generate objective assessment and informative feedback during the training. This study researched the performance curve of the adapted suturing module on the ProMIS Augmented Reality simulator. Eighteen novice participants were pretrained on the MIST-VR to become acquainted with laparoscopy. Subsequently, they practiced 16 knots on the suturing module, of which the assessment scores were recorded to evaluate the gain in laparoscopic suturing skills. The scoring of the assessment method was calculated from the "time spent in the correct area" during the knot tying and the quality of the knot. Both the baseline knot and the knot at the top of the performance curve were assessed by two independent objective observers, by means of a standardized evaluation form, to objectify the gain in suturing skills. There was a statistically significant difference between the scores of the second knot (mean 72.59, standard deviation (SD) 16.28) and the top of the performance curve (mean 95.82, SD 3.05; p < 0.001, paired t-test). The scoring of the objective observers also differed significantly (mean 11.83 and 22.11, respectively; SD 3.37 and 3.89, respectively; p < 0.001) (interobserver reliability Cronbach's alpha = 0.96). The median amount of repetitions to reach the top of the performance curve was eight, which also showed significant differences between both the assessment score (mean 88.14, SD 13.53, p < 0.001) and scoring of the objective observers of the second knot (mean 20.51, SD 4.14; p < 0.001). This adapted suturing module on the ProMIS Augmented Reality laparoscopic simulator is a potent tool for gaining laparoscopic suturing skills.
Ono, Y; Woodmass, J M; Nelson, A A; Boorman, R S; Thornton, G M; Lo, I K Y
This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P). Using standard suture loops pulled in-line with the rotator cuff (approximately 60°), anchors were tested in cadaveric bone and foam blocks representing normal to osteopenic bone. Mechanical testing included preloading to 10 N and cyclic loading for 500 cycles from 10 N to 60 N at 60 mm/min. The parameters evaluated were initial displacement, cyclic displacement and number of cycles and load at 3 mm displacement relative to preload. Video recording throughout testing documented the predominant source of suture displacement and the distance of 'suture cutting through bone'. In cadaveric bone and foam blocks, MultiFIX P anchors had significantly greater initial displacement, and lower number of cycles and lower load at 3 mm displacement than SpeedScrew anchors. Video analysis revealed 'suture cutting through bone' as the predominant source of suture displacement in cadaveric bone (qualitative) and greater 'suture cutting through bone' comparing MultiFIX P with SpeedScrew anchors in foam blocks (quantitative). The greater suture displacement in MultiFIX P anchors was predominantly from suture cutting through bone, which was enhanced in an osteopenic bone model. Anchors with sutures external to the anchor body are at risk for suture cutting through bone since the suture eyelet is at the distal tip of the implant and the suture directly abrades against the bone edge during cyclic loading. Suture cutting through bone may be a significant source of fixation failure, particularly in osteopenic bone.Cite this article: Y. Ono, J. M. Woodmass, A. A. Nelson, R. S. Boorman, G. M. Thornton, I. K. Y. Lo. Knotless anchors with sutures external to the anchor body may be at risk for suture cutting through osteopenic bone
Ono, Y.; Woodmass, J. M.; Nelson, A. A.; Boorman, R. S.; Thornton, G. M.
Objectives This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P). Methods Using standard suture loops pulled in-line with the rotator cuff (approximately 60°), anchors were tested in cadaveric bone and foam blocks representing normal to osteopenic bone. Mechanical testing included preloading to 10 N and cyclic loading for 500 cycles from 10 N to 60 N at 60 mm/min. The parameters evaluated were initial displacement, cyclic displacement and number of cycles and load at 3 mm displacement relative to preload. Video recording throughout testing documented the predominant source of suture displacement and the distance of ‘suture cutting through bone’. Results In cadaveric bone and foam blocks, MultiFIX P anchors had significantly greater initial displacement, and lower number of cycles and lower load at 3 mm displacement than SpeedScrew anchors. Video analysis revealed ‘suture cutting through bone’ as the predominant source of suture displacement in cadaveric bone (qualitative) and greater ‘suture cutting through bone’ comparing MultiFIX P with SpeedScrew anchors in foam blocks (quantitative). The greater suture displacement in MultiFIX P anchors was predominantly from suture cutting through bone, which was enhanced in an osteopenic bone model. Conclusions Anchors with sutures external to the anchor body are at risk for suture cutting through bone since the suture eyelet is at the distal tip of the implant and the suture directly abrades against the bone edge during cyclic loading. Suture cutting through bone may be a significant source of fixation failure, particularly in osteopenic bone. Cite this article: Y. Ono, J. M. Woodmass, A. A. Nelson, R. S. Boorman, G. M. Thornton, I. K. Y. Lo. Knotless anchors with sutures external to the anchor body may be
Song, Dongzhe; Zhang, Fugui; Reid, Russell R; Ye, Jixing; Wei, Qiang; Liao, Junyi; Zou, Yulong; Fan, Jiaming; Ma, Chao; Hu, Xue; Qu, Xiangyang; Chen, Liqun; Li, Li; Yu, Yichun; Yu, Xinyi; Zhang, Zhicai; Zhao, Chen; Zeng, Zongyue; Zhang, Ruyi; Yan, Shujuan; Wu, Tingting; Wu, Xingye; Shu, Yi; Lei, Jiayan; Li, Yasha; Zhang, Wenwen; Wang, Jia; Lee, Michael J; Wolf, Jennifer Moriatis; Huang, Dingming; He, Tong-Chuan
The cranial suture complex is a heterogeneous tissue consisting of osteogenic progenitor cells and mesenchymal stem cells (MSCs) from bone marrow and suture mesenchyme. The fusion of cranial sutures is a highly coordinated and tightly regulated process during development. Craniosynostosis is a congenital malformation caused by premature fusion of cranial sutures. While the progenitor cells derived from the cranial suture complex should prove valuable for studying the molecular mechanisms underlying suture development and pathogenic premature suture fusion, primary human cranial suture progenitors (SuPs) have limited life span and gradually lose osteoblastic ability over passages. To overcome technical challenges in maintaining sufficient and long-term culture of SuPs for suture biology studies, we establish and characterize the reversibly immortalized human cranial suture progenitors (iSuPs). Using a reversible immortalization system expressing SV40 T flanked with FRT sites, we demonstrate that primary human suture progenitor cells derived from the patent sutures of craniosynostosis patients can be efficiently immortalized. The iSuPs maintain long-term proliferative activity, express most of the consensus MSC markers and can differentiate into osteogenic and adipogenic lineages upon BMP9 stimulation in vitro and in vivo. The removal of SV40 T antigen by FLP recombinase results in a decrease in cell proliferation and an increase in the endogenous osteogenic and adipogenic capability in the iSuPs. Therefore, the iSuPs should be a valuable resource to study suture development, intramembranous ossification and the pathogenesis of craniosynostosis, as well as to explore cranial bone tissue engineering. © 2017 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.
Buezas, Guido; Becerra, Federico; Vassallo, Aldo
Due to their flexibility, sutures are regions that experience greater strains than the surrounding rigid cranial bones. Cranial sutures differ in their degree of interdigitation or complexity. There is evidence indicating that a more convoluted suture better enables the absorption of high stresses coming from dynamic masticatory forces, and other functions. The Order Rodentia is an interesting clade to study this because of its taxa with diverse chewing modes. Due to repeated loading resulting from gnawing and grinding, energy absorption by the sutures might be a crucial factor in these mammals. Species within the infraorder Caviomorpha were chosen as a case study because of their ecomorphological and dietary diversity. This study compared five sutures from the rostrum and cranial vault across seven caviomorph families, and assessed their complexity by means of the relative length and fractal dimension. Across these rodents, cranial sutures are morphologically quite diverse. We found that the sutures connecting the rostrum with the vault were relatively more interdigitated than those in the cranial vault itself, especially premaxillofrontal sutures. Suture interdigitation was higher in species that display chisel-tooth digging and burrowing behaviors, especially in the families Ctenomyidae and Octodontidae, than those in families Dasyproctidae and Cuniculidae, which have more gracile masticatory systems. The reconstruction of the ancestral character state, on family and species phylogeny, points toward low suture interdigitation (i.e., low length ratio) as a likely ancestral state for interfrontal, premaxillofrontal and maxillofrontal sutures. Interspecific differences in suture morphology shown here might represent adaptations to different mechanical demands (i.e., soft vs. tough foods) or behaviors (e.g., chisel-tooth digging), which evolved in close association with the diverse environments occupied by caviomorph rodents. © 2017 Wiley Periodicals, Inc.
Molokova, O A; Kecherukov, A I; Aliev, F Sh; Chernov, I A; Bychkov, V G; Kononov, V P
Morphological changes in the wall of the large intestine were studied after its manual suturing by a double-row interrupted suture with modern suture threads. Light and scanning electron microscopy showed "fuse properties" and "sawing effect" of polyfilament twisted threads (e.g. vicryl). Monofilament threads were free from these drawbacks and therefore were preferable. Metal elastic threads on the basis of titanium-nickelide alloys caused no inflammatory changes in tissues.
Wilson, Laura A B; Sánchez-Villagra, Marcelo R
Sutures, joints that allow one bone to articulate with another through intervening fibrous connective tissue, serve as major sites of bone expansion during postnatal craniofacial growth in the vertebrate skull and represent an aspect of cranial ontogeny which may exhibit functional and phylogenetic correlates. Suture evolution among hystricognath rodents, an ecologically diverse group represented here by 26 species, is examined using sequence heterochrony methods, i.e. event pairing and parsimov. Although minor nuances in suture closure sequence exist between species, the overall sequence was found to be conserved both across the hystricognath group and, to an increasing degree, within selected clades. At species level, suture closure pattern exhibited a significant positive correlation with patterns previously reported for hominoids. Patterns for most clades revealed the first sutures to close are those contacting the exoccipital, interparietal, and palatine bones. Heterochronic shifts were found along 19 of 35 branches within the hystricognath phylogeny. The number of shifts per node ranged from one to seven events and, overall, involved 21 of 34 suture sites. The topology generated by parsimony analyses of the event pair matrix yielded only one grouping that was congruent with the evolutionary relationships, compiled from morphological and molecular studies, taken as framework. Sutures contacting the exoccipital displayed the highest levels of most complete closure across all species. Level of suture closure is negatively correlated with cranial length (P < 0.05). Differing life history and locomotory strategies are coupled in part with differing suture closure patterns among several species. PMID:19245501
Phadnis, Joideep; Watts, Adam C
Olecranon fractures are common and often require surgical treatment when displaced. Traditional methods of stabilization using tension band wire fixation and plate fixation achieve adequate union and function but are associated with a high rate of re-operation and wound problems because of prominent metalwork. The purpose of the present article is to describe an all suture technique for fixation of simple olecranon fractures that maintains inter-fragmentary compression, provides bony union and reduces the rate of re-operation caused by prominent metalwork.
de Carvalho, Marcus Vinicius H.; Marchi, Evaldo; Lourenço, Edmir Américo
Introduction Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. Objective To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. Methods 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. Results In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002). In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002). Intraluminal adhesive penetration has not been noticed. Conclusion There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries. PMID:29267611
Chen, Shi-yi; Malcarney, Hilary L; Murrell, George A C
To evaluate results of margin convergence versus suture anchors in rotator cuff repair, and to determine which method is mechanically superior. Eighteen kangaroo shoulders were randomly divided into three groups (n = 6). A full thickness tendon defect 1.0 cm × 1.5 cm in size was created in the supraspinatus tendon at humeral insertion, simulating a massive rotator cuff tear. Three different techniques were employed for rotator cuff repair: (i) Mitek GII suture anchor alone (Group 1); (ii) margin convergence alone (Group 2); and (iii) margin convergence plus Mitek GII suture anchor (Group 3). Combined loads were applied to each specimen. After completion of cyclic loading, the construct was loaded to failure. ANOVA and LSD (Least Significant Difference) multiple comparisons of the means were applied to results. Cyclic load testing showed progressive gap formation in each repaired specimen with increasing cycles. Group 1 reached 50% failure at an average of 34 cycles, Group 2 at 75 cycles and Group 3 at 73 cycles. There were significant difference between Groups 1 and 2, and Groups 1 and 3 (P ≤ 0.001). After 100 loading cycles, the average gap size was 6.8 mm, 6.1 mm and 4.7 mm in Groups 1, 2 and 3, respectively. There was a significant difference between Groups 1 and 3 (P ≤ 0.015). All specimens eventually reached failure. Rotator cuff repairs with margin convergence +/- suture anchor were far stronger than suture anchor alone, both in gap formation and ultimate failure load. However, progressive gap formation with cyclic loading seems inevitable after cuff repair, which may facilitate clinical understanding of the phenomena of re-tear or residual defect. © 2009 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.
Walker, Ricardo W.; Brown, Richard S.; Deters, Katherine A.
Ultraviolet radiation (UVR) can be used as a tool to disinfect surgery tools used for implanting transmitters into fish. However, the use of UVR could possibly degrade monofilament suture material used to close surgical incisions. This research examined the effect of UVR on monofilament sutures to determine if they were compromised and negatively influenced tag and suture retention, incision openness, or tissue reaction. Eighty juvenile Chinook salmon Oncorhynchus tshawytscha were surgically implanted with an acoustic transmitter and a passive integrated transponder. The incision was closed with a single stitch of either a suture exposed to 20 doses of UV radiationmore » (5 minute duration per dose) or a new, sterile suture. Fish were then held for 28 d and examined under a microscope at day 7, 14, 21 and 28 for incision openness, ulceration, redness, and the presence of water mold. There was no significant difference between treatments for incision openness, redness, ulceration or the presence of water mold on any examination day. On day 28 post-surgery, there were no lost sutures; however, 2 fish lost their transmitters (one from each treatment). The results of this study do not show any differences in negative influences such as tissue response, suture retention or tag retention between a new sterile suture and a suture disinfected with UVR.« less
Ventura, Liliane; Oliveira, Gunter C. D.; De Groote, Jean-Jacques; Sousa, Sidney J. F.; Saia, Paula
A system for ophthalmic surgery support has been developed in order to minimize the residual astigmatism due to the induced irregular shape of the cornea by corneal suture. The system projects 36 light spots, from LEDs, displayed in a precise circle at the lachrymal film of the examined cornea. The displacement, the size and deformation of the reflected image of these light spots are analyzed providing the keratometry and the circularity of the suture. Measurements in the range of 32D - 55D (up to 23D of astigmatism are possible to be obtained) and a self-calibration system has been designed in order to keep the system calibrated. Steel precision spheres have been submitted to the system and the results show 99% of correlation with the fabricant's nominal values. The system has been tested in 13 persons in order to evaluate its clinical applicability and has been compared to a commercial keratometer Topcon OM-4. The correlation factors are 0,92 for the astigmatism and 0.99 for the associated axis. The system indicates that the surgeon should achieve circularity >=98% in order to do not induce astigmatisms over 3D.
Abiri, Ahmad; Paydar, Omeed; Tao, Anna; LaRocca, Megan; Liu, Kang; Genovese, Bradley; Candler, Robert; Grundfest, Warren S; Dutson, Erik P
Robotic surgical platforms have seen increased use among minimally invasive gastrointestinal surgeons (von Fraunhofer et al. in J Biomed Mater Res 19(5):595-600, 1985. doi: 10.1002/jbm.820190511 ). However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures (Barbash et al. in Ann Surg 259(1):1-6, 2014. doi: 10.1097/SLA.0b013e3182a5c8b8 ). This work catalogs tensile strength and failure load among commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force. Polydioxanone, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pull rate on failure load at rates of 50, 200, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in unlooped, looped, and at the needle body arrangements. Generally, Vicryl and PDS sutures had the highest mechanical strength (47-179 kN/cm 2 ), while Silk had the lowest (40-106 kN/cm 2 ). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27-50% improvement in the tensile strength over data obtained in 1985 (Ballantyne in Surg Endosc Other Interv Tech 16(10):1389-1402, 2002. doi: 10.1007/s00464-001-8283-7 ). No significant differences were observed when sutures were pulled at different rates. Reduction in suture strength appeared to be strongly affected by the technique used to manipulate the suture. Availability of suture tensile strength and failure load data will help define software safety
Cho, Yang Kyeung
Purpose To evaluate the factors that affect postoperative astigmatism and post-suture removal astigmatism, and to evaluate the risk factors associated with astigmatism axis shift. Methods We performed a retrospective chart review of 130 eyes that had undergone uneventful phacoemulsification cataract surgery. Preoperative astigmatism was divided into four groups (Groups I, II, III, and IV) according to the differences between the axis of preoperative astigmatism (flattest axis) and the incision axis (105 degrees). We analyzed the magnitude and axis of the induced astigmatism after the operation and after suture removal in each group. We also analyzed the factors which affected the postoperative astigmatism and post-suture removal astigmatism in each sub-group of Groups I, II, III, and IV, excluding postoperative or post-suture removal axis shift (specifically, Group IWAS, IIWAS, IIIWAS, and IVWAS). We identified the variables associated with the prevalence of postoperative astigmatism axis shift and those associated with the prevalence of post-suture removal axis shift. Results An increase in the magnitude of postoperative astigmatism was associated with an increase in the preoperative magnitude of astigmatism in Groups IWAS, IIWAS, and IIIWAS (p<0.05), and with an increase in the corneal tunnel length in Group IWAS. A decrease in the magnitude of postoperative astigmatism was associated with an increase in the corneal tunnel length in Groups IIIWAS and IVWAS (p<0.05). An increase in the magnitude of post-suture removal astigmatism was associated with an increase in the magnitude of postoperative astigmatism in Groups IWAS and IVWAS (p<0.05), and with late suture removal in Group IVWAS (p<0.05). A decrease in the magnitude of post-suture removal astigmatism was associated with late suture removal in Groups IWAS and IIWAS. A logistic regression analysis showed that the prevalence of post-suture removal astigmatism axis shift was associated with increased corneal
González-Barnadas, Albert; Camps-Font, Octavi; Espanya-Grifoll, Dunia; España-Tost, Antoni; Figueiredo, Rui; Valmaseda-Castellón, Eduard
Suture technique and materials are important in preventing complications such as wound dehiscences. The purpose of this study was to determine the tensile strength of different suturing techniques, comparing several materials with different diameters. One hundred sixty sutures were performed using silk, e-PTFE, and 2 types of polyamide (monofilament and Supramid). Ten simple, 10 horizontal mattress, and 10 combinations of the two stitches were performed with 4-0 gauge of each material. Additionally, 10 simple sutures were performed with the 5-0 gauge of each material. The maximum tensile force resisted by each suture was recorded. When 5 mm of traction was applied, the polyamide monofilament resisted significantly better without untying or breaking compared with Supramid or silk, while the e-PTFE was superior to all the others. However, the force when e-PTFE 4-0 sutures untied or broke was lower than for either type of polyamide. The combined technique withstood a significantly higher tensile force before unknotting or breaking than did the simple and mattress stitches. The 5-0 gauges of silk and both types of polyamide showed lower tensile strengths than the 4-0 materials. Among the 5-0 sutures, Supramid showed a higher tensile strength than silk. The combined suture technique possessed greater tensile strength than did a simple or a horizontal mattress suture, and e-PTFE 4-0 withstood more traction without untying or breaking than did all the other materials, although at a lower tensile force. With the exception of e-PTFE, 4-0 sutures had greater tensile strength than did 5-0 sutures.
Maloul, Asmaa; Fialkov, Jeffrey; Wagner, Diane; Whyne, Cari M
Characterizing the biomechanical behavior of sutures in the human craniofacial skeleton (CFS) is essential to understand the global impact of these articulations on load transmission, but is challenging due to the complexity of their interdigitated morphology, the multidirectional loading they are exposed to and the lack of well-defined suture material properties. This study aimed to quantify the impact of morphological features, direction of loading and suture material properties on the mechanical behavior of sutures and surrounding bone in the CFS. Thirty-six idealized finite element (FE) models were developed. One additional specimen-specific FE model was developed based on the morphology obtained from a µCT scan to represent the morphological complexity inherent in CFS sutures. Outcome variables of strain energy (SE) and von Mises stress (σvm) were evaluated to characterize the sutures' biomechanical behavior. Loading direction was found to impact the relationship between SE and interdigitation index and yielded varied patterns of σvm in both the suture and surrounding bone. Adding bone connectivity reduced suture strain energy and altered the σvm distribution. Incorporating transversely isotropic material properties was found to reduce SE, but had little impact on stress patterns. High-resolution µCT scanning of the suture revealed a complex morphology with areas of high and low interdigitations. The specimen specific suture model results were reflective of SE absorption and σvm distribution patterns consistent with the simplified FE results. Suture mechanical behavior is impacted by morphologic factors (interdigitation and connectivity), which may be optimized for regional loading within the CFS. © 2013 Elsevier Ltd. All rights reserved.
Sarsam, Omar Matthieu; Dunning, Joel; Pochulu, Bruno; Baste, Jean-Marc
We describe in this article our bronchoplastic robot-assisted techniques. This consists of using continuous barbed sutures. Our aim is to show the feasibility and the interest of using robotics and this kind of suture material for complex bronchial procedures. We report four cases in France and the UK, two wedge bronchoplasties and two sleeve bronchoplasties for central pulmonary tumors.
Sarsam, Omar Matthieu; Dunning, Joel; Pochulu, Bruno
We describe in this article our bronchoplastic robot-assisted techniques. This consists of using continuous barbed sutures. Our aim is to show the feasibility and the interest of using robotics and this kind of suture material for complex bronchial procedures. We report four cases in France and the UK, two wedge bronchoplasties and two sleeve bronchoplasties for central pulmonary tumors. PMID:29445589
Miroshnichenko, Kateryna; Liu, Lei; Tsukrov, Igor; Li, Yaning
A composite model for suture joints with a connective layer of aligned fibers embedded in soft matrix is proposed. Based on the principle of complementary virtual work, composite cylinder assemblage (CCA) approach and generalized self-consistent micro-mechanical models, a hierarchical homogenization methodology is developed to systematically quantify the synergistic effects of suture morphology and fiber orientation on the overall mechanical properties of sutures. Suture joints with regular triangular wave-form serve as an example material system to apply this methodology. Both theoretical and finite element mechanical models are developed and compared to evaluate the overall normal stiffness of sutures as a function of wavy morphology of sutures, fiber orientation, fiber volume fraction, and the mechanical properties of fibers and matrix in the interfacial layer. It is found that generally due to the anisotropy-induced coupling effects between tensile and shear deformation, the effective normal stiffness of sutures is highly dependent on the fiber orientation in the connective layer. Also, the effective shear modulus of the connective layer and the stiffness ratio between the fiber and matrix significantly influence the effects of fiber orientation. In addition, optimal fiber orientations are found to maximize the stiffness of suture joints.
Wei, Wei; Li, Yuxiao; Yang, Huazhe; Nassab, Reza; Shahriyari, Fatemeh; Akpek, Ali; Guan, Xiaofei; Liu, Yanhui; Taranejoo, Shahrouz; Tamayol, Ali; Zhang, Yu Shrike; Khademhosseini, Ali; Jang, Hae Lin
Sutures are one of the most widely used devices for adhering separated tissues after injury or surgery. However, most sutures require knotting, which can create a risk of inflammation, and can act as mechanically weak points that often result in breakage and slipping. Here, an anchoring suture is presented with a design that facilitates its propagation parallel to the suturing direction, while maximizing its resistive force against the opposite direction of external force to lock its position in tissues. Different microstructures of suture anchors are systematically designed using orthogonal arrays, and selected based on shape factors associated with mechanical strength. 3D printing is used to fabricate different types of hollow microstructured suture anchors, and optimize their structure for the effective shaping of tissues. To define the structural design for fixing tissues, the maximum force required to pull 3D printed anchors in different directions is examined with tissues. The tissue reshaping function of suture anchors is further simulated ex vivo by using swine ear, nose, and skin, and bovine muscle tendon. This study provides advantages for building functional sutures that can be used for permanently reshaping tissues with enhanced mechanical strength, eliminating the need for knotting to improve surgical efficiency. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Neurosurgical suture needle. 882.4650 Section 882.4650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4650 Neurosurgical suture needle...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neurosurgical suture needle. 882.4650 Section 882.4650 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4650 Neurosurgical suture needle...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Controls Guidance Document: Surgical Sutures; Guidance for Industry and FDA.” See § 878.1(e) for the...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...: Surgical Sutures; Guidance for Industry and FDA.” See § 878.1(e) for the availability of this guidance...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture. (a...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention device...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture. (a...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture. (a...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention device...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention device...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Stainless steel suture. 878.4495 Section 878.4495 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4495 Stainless steel suture. (a...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention device...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Suture retention device. 878.4930 Section 878.4930 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4930 Suture retention device...
Tanaka, Masaaki; Hori, Yoshiaki; Shirafuji, Aya; Kato, Mitsunori; Kato, Jyun; Kobayashi, Hiroto; Tsuchida, Toru; Fukae, Tsukasa
To create awareness about a surgical technique termed bridge suture, which is performed as a pretreatment before a McDonald cerclage is performed on an emergency to treat severe cervical insufficiency. Procedures for bridge suture were reviewed in detail and outcomes of 16 patients treated with bridge suture followed by McDonald cerclage were evaluated retrospectively. Using the bridge suture, the edges of uterine cervix were temporarily sutured and the external uterine os was closed, while the hourglass-shaped fetal membranes were concomitantly confined within the cervix; subsequently, a McDonald cerclage was performed. Over a 22-year period, 16 patients with a dilated cervix and bulging fetal membranes were treated using the technique of bridge suture followed by an emergency cerclage. The mean gestational age at cerclage was 22.5 weeks; the mean gestational age at delivery was 30.7 weeks; and the mean interval between cerclage and delivery was 8.2 weeks. In 15 out of 16 cases, cerclage was performed without encountering any complications. No maternal complications, including cervical laceration, were observed. The mean body weight of 17 neonates, including that of a twin, was 1,516 g and of them, 15 neonates survived. The important outcome of bridge suture is the replacement of fetal membranes back into the uterine cavity before McDonald's cerclage is performed. Pretreatment with bridge suture may facilitate the performance of a successful emergency cerclage and contribute to good maternal and neonatal outcomes. © 2016 S. Karger AG, Basel.
Alecu, L; Pascu, A; Deacu, A; Corodeanu, G; Marin, A; Costan, I
Of this working is the study of employment the mechanical suture in general surgery classic and laparoscopic. We analysed the possibility of accomplishment and postoperatory evolution of 104 mechanical sutures performed in 24 patients, with diverse surgery pathology, operated in Department of General Surgery, between January 1999 and January 2000. Mechanical sutures allowed us to minimize the duration of surgical interventions and to perform some difficult anastomotic assembles (sometimes including creation of organ substitute). We had only two postoperatory fistulas and two postoperatory haemorrhages from anastomotic area (both cases because of bad closing of clips, through tissue excess between anvil and cartridge of the stapler). There are certain advantages in using mechanical sutures (versus manual sutures) consisting in decreasing of time period, both in operation itself and in hospitalization, despite their high level cost.
Herring, Susan W.; Teng, Shengyi
The skull is distinguished from other parts of the skeleton by its composite construction. The sutures between bony elements provide for interstitial growth of the cranium, but at the same time they alter the transmission of stress and strain through the skull. Strain gages were bonded to the frontal and parietal bones of miniature pigs and across the interfrontal, interparietal and coronal sutures. Strains were recorded 1) during natural mastication in conjunction with electromyographic activity from the jaw muscles and 2) during stimulation of various cranial muscles in anesthetized animals. Vault sutures exhibited vastly higher strains than did the adjoining bones. Further, bone strain primarily reflected torsion of the braincase set up by asymmetrical muscle contraction; the tensile axis alternated between +45° and −45° depending on which diagonal masseter/temporalis pair was most active. However, suture strains were not related to overall torsion but instead were responses to local muscle actions. Only the coronal suture showed significant strain (tension) during jaw opening; this was caused by the contraction of neck muscles. All sutures showed strain during jaw closing, but polarity depended on the pattern of muscle usage. For example, masseter contraction tensed the coronal suture and the anterior part of the interfrontal suture, whereas the temporalis caused compression in these locations. Peak tensile strains were larger than peak compressive strains. Histology suggested that the skull is bent at the sutures, with the ectocranial surface tensed and the endocranial surface predominantly compressed. Collectively, these results indicate that skulls with patent sutures should be analyzed as complexes of independent parts rather than solid structures. PMID:10918130
Fares, Usama; Mokashi, Aashish A; Al-Aqaba, Mouhamed Ali; Otri, Ahmad Muneer; Miri, Ammar; Dua, Harminder Singh
To analyse the efficacy of paired arcuate incisions and compression sutures technique in the management of post penetrating keratoplasty (PK) astigmatism. A paired arcuate incision with compression sutures procedure was used to treat 26 eyes with post-PK astigmatism ranging from 6.00 to 16.50 dioptres (D). The incisions were placed at the 7.0 mm optical zone inside the graft-host junction at a depth of 80% of corneal thickness. A 45° paired arc length was planned for eyes with preoperative astigmatism between 6D and 9D, and a 60° paired arc length was planned for eyes with preoperative astigmatism of >9D. At 3 months, corneal topography and refraction was performed and suture(s) removed if indicated. Net and vector astigmatism changes were calculated to determine the efficacy of the procedure. The indications for PK included keratoconus, Fuch's endothelial dystrophy, pseudophakic bullous keratopathy and corneal scar. There was a statistically significant reduction in the mean magnitude of astigmatism from 9.66 ± 2.90D preoperatively to 4.37 ± 2.53D postoperatively in the whole group. The mean decrease in the astigmatism was 4.37 ± 2.05D (58.4%) and 6.23 ± 3.63D (52.6%) in patients with 6-9D and >9D, respectively. Vector power calculations also showed a significant astigmatism reduction in all groups. The safety and efficacy indices were 1.40 and 0.28, respectively. Manual astigmatic keratotomy is a viable technique with relatively good safety and efficacy outcomes. Based on the results we propose that increasing the arc length to a minimum of 60° for astigmatism of 6-9D, and to 75° for astigmatism >9D, is likely to have a greater beneficial effect.
Kim, Dong-Kyu; Kim, Seung Kyun; Lee, Jun Ho; Park, Chan Hum
Various methods have been used to treat zygomatic arch fractures, but no optimal modality exists for reducing these fractures and supporting the depressed bone fragments without causing esthetic problems and discomfort for life. We developed a novel aqua splint and suture technique for stabilizing isolated zygomatic arch fractures. The objective of this study is to evaluate the effect of novel aqua splint and suture technique in isolated zygomatic arch fractures. Patients with isolated zygomatic arch fractures were treated by a single surgeon in a single center from January 2000 through December 2012. Classic Gillies approach without external fixation was performed from January 2000 to December 2003, while the novel technique has been performed since 2004. 67 consecutive patients were included (Classic method, n = 32 and Novel method, n = 35). An informed consent was obtained from all patients. The novel aqua splint and suture technique was performed by the following fashion: first, we evaluated intraoperatively the bony alignment by ultrasonography and then, reduced the depressed fracture surgically using the Gillies approach. Thereafter, to stabilize the fracture and obtain the smooth facial figure, we made an aqua splint that fit the facial contour and placed monofilament nonabsorbable sutures around the fractured zygomatic arch. The novel aqua splint and suture technique showed significantly correlated with better cosmetic and functional results. In conclusion, the aqua splint suture technique is very simple, quick, safe, and effective for stabilizing repositioned zygomatic arch fractures. The aqua splint suture technique can be a good alternative procedure in isolated zygomatic arch fractures.
Barber, F Alan; Herbert, Morley A; Crates, John M
Lateral ankle ligament repairs increasingly use suture anchors instead of bone tunnels. Our purpose was to compare the biomechanical properties of a knotted and knotless suture anchor appropriate for a lateral ankle ligament reconstruction. In porcine distal fibulae, 10 samples of 2 different PEEK anchors were inserted. The attached sutures were cyclically loaded between 10N and 60N for 200 cycles. A destructive pull was performed and failure loads, cyclic displacement, stiffness, and failure mode recorded. PushLock 2.5 anchors failed before 200 cycles. PushLock 100 cycle displacement was less than Morphix 2.5 displacement (p<0.001). Ultimate failure load for anchors completing 200 cycles was 86.5N (PushLock) and 252.1N (Morphix) (p<0.05). The failure mode was suture breaking for all PushLocks while the Morphix failed equally by anchor breaking and suture breakage. The knotted Morphix demonstrated more displacement and greater failure strength than the knotless PushLock. The PushLock failed consistently with suture breaking. The Morphix anchor failed both by anchor breaking and by suture breaking. Copyright © 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I
Patterns of ectocranial suture fusion among Primates are subject to species-specific variation. In this study, we used Guttman Scaling to compare modal progression of ectocranial suture fusion among Hominidae (Homo, Pan, Gorilla, and Pongo), Hylobates, and Cercopithecidae (Macaca and Papio) groups. Our hypothesis is that suture fusion patterns should reflect their evolutionary relationship. For the lateral-anterior suture sites there appear to be three major patterns of fusion, one shared by Homo-Pan-Gorilla, anterior to posterior; one shared by Pongo and Hylobates, superior to inferior; and one shared by Cercopithecidae, posterior to anterior. For the vault suture pattern, the Hominidae groups reflect the known phylogeny. The data for Hylobates and Cercopithecidae groups is less clear. The vault suture site termination pattern of Papio is similar to that reported for Gorilla and Pongo. Thus, it may be that some suture sites are under larger genetic influence for patterns of fusion, while others are influenced by environmental/biomechanic influences. Copyright © 2013 Wiley Periodicals, Inc.
8063/10238/$00.00 doi:10.1016/j.arthro.2011.02.003 834 Arthroscopy : The Journal of Arthroscopic and Related Surgery, Vol 27, No 6 (June), 2011: pp 834...Herbert MA, Coons DA, Boothby MH. Sutures and suture anchors—Update 2006. Arthroscopy 2006;22:1063- 1069. 2. Barber FA, Herbert MA, Beavis RC. Cyclic... Arthroscopy 2007;23:884-888. 5. Wust DM, Meyer DC, Favre P, Gerber C. Mechanical and handling properties of braided polyblend polyethylene sutures in
Göpel, Tobias; Härtl, Felix; Schneider, Armin; Buss, Martin; Feussner, Hubertus
In minimally invasive surgery, hand suturing is categorized as a challenge in technique as well as in its duration. This calls for an easily manageable tool, permitting an all-purpose, cost-efficient, and secure viscerosynthesis. Such a tool for this field already exists: the Autosuture EndoStitch(®). In a series of studies the potential for the EndoStitch to accelerate suturing has been proven. However, its ergonomics still limits its applicability. The goal of this study was twofold: propose an optimized and partially automated EndoStitch and compare the conventional EndoStitch to the optimized and partially automated EndoStitch with respect to the speed and precision of suturing. Based on the EndoStitch, a partially automated suturing tool has been developed. With the aid of a DC motor, triggered by a button, one can suture by one-fingered handling. Using the partially automated suturing manipulator, 20 surgeons with different levels of laparoscopic experience successfully completed a continuous suture with 10 stitches using the conventional and the partially automated suture manipulator. Before that, each participant was given 1 min of instruction and 1 min for training. Absolute suturing time and stitch accuracy were measured. The quality of the automated EndoStitch with respect to manipulation was tested with the aid of a standardized questionnaire. To compare the two instruments, t tests were used for suturing accuracy and time. Of the 20 surgeons with laparoscopic experience (fewer than 5 laparoscopic interventions, n=9; fewer than 20 laparoscopic interventions, n=7; more than 20 laparoscopic interventions, n=4), there was no significant difference between the two tested systems with respect to stitching accuracy. However, the suturing time was significantly shorter with the Autostitch (P=0.01). The difference in accuracy and speed was not statistically significant considering the laparoscopic experience of the surgeons. The weight and size of the
Achtnich, A; Rosslenbroich, S; Beitzel, K; Imhoff, A B; Petersen, W
Arthroscopic assisted suture anchor refixation combined with microfracturing of the femoral ACL insertion zone in cases of acute proximal anterior cruciate ligament (ACL) rupture to restore anatomical and biomechanical properties of the native ACL. Acute proximal ACL rupture/avulsion, multiligament injury of the knee CONTRAINDICATIONS: Chronic (>6 weeks) proximal ACL rupture, intraligamentary rupture, as well as previous ACL surgery. Arthroscopic examination of the knee joint, debridement of the femoral insertion zone, examination of the ligament quality by a probe, insertion of a curved lasso through the ACL to place the sutures and use of a drill guide to place the anchor in the middle of the femoral ACL insertion. Microfracturing holes around the femoral footprint were made by an awl to enhance healing properties of the ACL. Partial weight bearing was permitted and crutches were used for 6 weeks, knee brace limited for the first 2 weeks 0‑0-0°, then 0‑0-90° for the following 4 weeks. A total of 20 patients who underwent acute proximal ACL suture anchor refixation were evaluated after a mean follow-up of 28 months. Regarding stability, mean values of the KT-1000 arthrometer indicated stable results (<3 mm), 3 patients had a 1+ Lachman and 4 patients had a 1+ pivot shift. IKDC (International Knee Documentation Committee) score indicated that 17 cases were very good to good (12A, 4B) and in 3 cases the results were satisfactory (3C). Magnetic resonance imaging showed that the ALC was found to be intact in 17 cases. The total rate of revision was 15 % (3/20) because of recurrent instability.
Brown, Dennis; Feng, Kuan-Fu; Wu, Yih-Min; Huang, Hsin-Hua
Imaging high-pressure rock exhumation in active tectonic settings is considered to be one of the important observations that could potentially help to move forward the understanding of how this process works. Petrophysical analyses carried out along a high velocity zone imaged by seismic travel time tomography along the suture zone between the actively colliding Luzon Arc and the southeastern margin of Eurasia in Taiwan suggests that high-pressure rocks are being exhumed from at least a depth of 50 km below the arc-continent suture to the shallow subsurface where they coincide with an outcropping tectonic mélange called the Yuli Belt. The Yuli Belt comprises mainly greenschist facies quartz-mica schist, with lesser metabasite, metamorphosed mantle fragments and, importantly, minor blueschist. Modeling of published data bases of measured seismic velocities for a large suite of rocks suggests that all of the Yuli belt lithologies fit well with the measured Vp, Vs, and Vp/Vs at ambient pressures and temperatures (a 20 oC/km geotherm is used) from 10 to about 20 km depth. With the exception of hornblendite, mantle rocks need 30% to 40 % serpentinization to approximate the in situ range of Vp and and Vs at these depths. From about 20 km to 30 km, most continental crust and volcanic arc lithologies move out of the range of velocities measured by the tomography model at these depths. Blueschist (including the calculated Vp and Vs for the Yuli Belt samples), pyroxenite, and harzburgite, lherzolite, and dunite with around 20% to 30% serpentinization now enter into the range of velocities for these depths. From 40 km to 50 km depth, the mantle rocks pyroxenite, and weakly to unserpentinized harzburgite, lherzolite, and dunite, together with mafic eclogite velocities best fit the range of Vp, Vs and Vp/Vs at these depths. Seismicity along the arc-continent suture, the upper bounding fault of the high velocity zone examined here, indicate that it is a moderately oblique
In different tables the most important faults with enteral sutures and anastomoses in general and at special operations are demonstrated: end-to-end anastomoses with congruent diameter, anastomoses with different diameters, B I, B II, low anterior resection, esophago-jejunostomy. Only if the surgeon has experience in standard technique, faults and risks with mechanical staplers and manual sutures, the advantage-progress of staplers will be effective avoiding special risks. Surgeons without experience may produce real catastrophes which may turn out hopeless without training in manual suture technique.
Smith, Daniel J.; Brat, Gabriel A.; Medina, Scott H.; Tong, Dedi; Huang, Yong; Grahammer, Johanna; Furtmüller, Georg J.; Oh, Byoung Chol; Nagy-Smith, Katelyn J.; Walczak, Piotr; Brandacher, Gerald; Schneider, Joel P.
Many surgeries are complicated by the need to anastomose, or reconnect, micrometre-scale vessels. Although suturing remains the gold standard for anastomosing vessels, it is difficult to place sutures correctly through collapsed lumen, making the procedure prone to failure. Here, we report a multiphase transitioning peptide hydrogel that can be injected into the lumen of vessels to facilitate suturing. The peptide, which contains a photocaged glutamic acid, forms a solid-like gel in a syringe and can be shear-thin delivered to the lumen of collapsed vessels (where it distends the vessel) and the space between two vessels (where it is used to approximate the vessel ends). Suturing is performed directly through the gel. Light is used to initiate the final gel-sol phase transition that disrupts the hydrogel network, allowing the gel to be removed and blood flow to resume. This gel adds a new tool to the armamentarium for micro- and supermicrosurgical procedures.
Linz, C; Kunz, F; Krauß, J; Böhm, H; Wirth, C; Hartmann, S; Wirbelauer, J; Schweitzer, T
The present study analyses the exclusive use of absorbable suture material (Vicryl(®), Ethicon, Germany) in the fixation of transposed bone segments in craniofacial surgery without modification of the osteotomy design. Among 129 children up to 24 months of age, osteosynthesis was conducted exclusively with Vicryl(®) sutures. The stability of postoperative results was evaluated and possible foreign body reactions were examined within the framework of clinical and radiological routine checks. All examined children exhibited stable postoperative conditions while the length of hospital stay was not affected. X-ray examinations of the skull in two planes demonstrated good bony union in all cases. Relevant foreign body reactions were not observed. The exclusive application of absorbable suture material enables stable and cost effective osteosynthesis. Significant foreign body reactions were not observed. The exclusive use of absorbable sutures did not alter the osteotomy design. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Barber, F Alan; Coons, David A; Ruiz-Suarez, Michell
The purpose of this study was to test 4 different biodegradable suture anchors threaded with 2 high-strength sutures under cyclic loading conditions in humeral cadaveric specimens divided into 2 different age groups. Thirty-two paired human cadaveric humeri were stripped of all soft tissue. Two groups were studied: group 1, in which the mean age was 54 years, and group 2, in which the mean age was 70 years. We placed 1 suture anchor at 3 humeral sites per bone (anterior, middle, and posterior greater tuberosity). We tested 24 specimens using each of 4 anchors: TwinFix AB (Smith & Nephew Endoscopy, Andover, MA), BioZip (Stryker Endoscopy, San Jose, CA), Bio-Corkscrew FT (Arthrex, Naples, FL), and SpiraLok (DePuy Mitek, Raynham, MA). The anchor's sutures were grasped with an Instron clamp (Instron, Canton, MA), preloaded, and cycled from 10 to 60 N 500 times, followed by destructive testing. The mean displacement at 500 cycles, yield loads, failure modes, and ultimate loads were recorded. Most cyclic motion occurred during the first 100 cycles. More motion occurred in older bones than in younger bones (P < .05). The mean yield loads were greater for the young group for the SpiraLok anchors than for Bio-Corkscrew FT anchors in the young and old groups (P < .001), TwinFix anchors in the old group (P < .05), and BioZip anchors in the old group (P < .05). The ultimate failure loads for SpiraLok anchors in the young group were greater than for Bio-Corkscrew FT anchors in the young and old groups and BioZip anchors in the old group (P < .05). In group 1 TwinFix AB (P = .01) and BioZip (P = .02) ultimate loads were statistically greater than that for Bio-Corkscrew FT. The TwinFix AB failed by anchor pullout. The Bio-Corkscrew FT failed by eyelet pullout. The BioZip and SpiraLok pulled out in older bone and experienced eyelet breakage in younger bone. None of the 4 anchors reached 5 mm of displacement even after 500 loading cycles. Most of the displacement occurred in the
Jan, N; Sonnery-Cottet, B; Fayard, J-M; Kajetanek, C; Thaunat, M
All-inside posteromedial suture for lesions of the posterior horn of the medial meniscus in anterior cruciate ligament (ACL) repair provides effective freshening and good healing. The posteromedial portal provides satisfactory healing rates without increasing morbidity or complications rates. Intra- and postoperative complications were collected for a consecutive single-center series of 132 patients undergoing posteromedial hook suture of the medial meniscus in ACL repair. Meniscal healing was assessed as the rate of recurrence of symptomatic medial meniscus lesions (Barret criteria) and on revision surgery, if any, in terms of the aspect and extent of the iterative lesion. The severity of any sensory disorder was assessed by questionnaire. The intraoperative complications rate was 1.5% (2 saphenous vein punctures). At a mean 31months (range, 28-35months), there was no loss to follow-up. Twelve patients (9%) showed symptomatic recurrence of the medial meniscus lesion, requiring 10 repeat surgeries. In 6 cases (4.5%), the iterative lesion involved a smaller, more central part of the meniscus anterior to the sutures, of "postage-stamp" effect, possibly implicating the suture hook and/or non-absorbable sutures. There were no cases of infection or fistula. Postoperative hematoma occurred in 7% of patients. In total, 1.8% reported dysesthesia areas equal to or greater than the size of a credit card (45cm 2 ). Some retears, or "partial failures", may implicate a new lesion caused by the suture hook and possibly prolonged by non-resorbable sutures. Hematoma and sensory disorder rates were comparable to those reported in isolated ACL repair without posteromedial portal. The present results show that posteromedial arthroscopic hook suture in posterior medial meniscus tear provides good healing rates without increased morbidity due to the supplementary portal. IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Fanter, Nathan J; Davis, Edward W; Baker, Champ L
In the operative treatment of Achilles insertional tendinopathy, no guidelines exist concerning which form of fixation of the Achilles tendon insertion is superior. Transcalcaneal drill pin passage does not place any major plantar structures at risk, and the addition of a Krackow stitch and suture button to the fixation technique provides a significant increase in ultimate load to failure in Achilles tendon insertional repairs. Controlled laboratory study. The Achilles tendon insertions in 6 fresh-frozen cadaveric ankles were detached, and transcalcaneal drill pins were passed. Plantar dissection took place to evaluate the drill pin relationship to the plantar fascia, lateral plantar nerve and artery, flexor digitorum longus tendon, and master knot of Henry. The Achilles tendons were then repaired with a double-row suture anchor construct alone or with a suture button and Krackow stitch added to the double-row suture anchor construct. The repairs were then tested to maximum load to failure at 20 mm/min. The mode of failure was recorded, and the mean maximum load to failure was assessed using the Student t test for distributions with equal variance. Transcalcaneal drill pin passage did not place any selected anatomic structures at risk. The mean maximum load to failure for the suture bridge group was 239.2 N; it was 391.4 N for the group with the suture button (P = .014). The lateral plantar artery was the structure placed at greatest risk from drill pin placement, with a mean distance of 22.7 mm (range, 16.5-29.2 mm) between the pin and artery. In this laboratory study, transcalcaneal drill pin passage appeared to be anatomically safe, and the use of suture button technology with a Krackow stitch for Achilles tendon insertional repair significantly increased repair strength. Achilles tendon insertional repair with suture button fixation and a Krackow stitch may facilitate the earlier institution of postoperative rehabilitation and improve clinical outcomes.
Chu, Haikun; Xu, Yanbin; Chu, Haipeng; Xu, Yajun; Zhou, Fengji; Yu, Xin; Li, Hui; Ji, Xiaofeng
To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P > 0.05). In improved group, the patients achieved healing of incisions by first intention after operation and no complication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 +/- 6.6) minutes] was significantly shorter (t=-12.29, P=0.00) than that of conventional group [(52.3 +/- 6.9) minutes]; the blood loss of improved group [(4.9 +/- 2.0) mL] was significantly less (t=-25.20, P=0.00) than that of conventional group [(40.7 +/- 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 +/- 1.0 in improved group and was 98.4 +/- 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.
Taube, M.; Porter, R. J.; Lord, P. H.
We have conducted a controlled trial to compare skin closure using conventional interrupted sutures with a combination of subcuticular suture and sterile Micropore tape in 169 patients undergoing appendicectomy, inguinal herniorrhaphy, or saphenofemoral ligation. We have found that the combination technique consistently gives a better cosmetic result and that the tape acts well as a dressing, is convenient, and is well tolerated by patients. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:6344732
Zhao, Bin-xiu; Wang, Kun-zheng; Wang, Chun-sheng; Xie, Yue; Dai, Zhi-tang; Liu, Gang; Liu, Wei-dong
For the calcaneal avulsion fracture, the current method is more commonly used screws or Kirschner wire to fix fracture fragment. This article intended to explore the feasibility and clinical efficacy for the treatment of avulsion fractures with TwinFix suture anchors. From July 2007 to November 2010, 21 patients were reviewed, including 15 males and 6 females, ranging in age from 49 to 65 years,with a mean of 58.7 years. Twelve patients had nodules in the right heel and 9 patients had nodules in the left heel. All the patients had closed fractures. The typical preoperative symptoms of the patients included pain in the upper heel and weak in heel lift. Body examination results: palpable sense of bone rubbing in the back of the heel, and swelling in the heel. Surgery treatment with TwinFix suture anchors performed as follows : to fix TwinFix suture anchors into the calcaneal body, then to drill the fracture block, to make the double strand suture through the fracture holes, to knot the suture eachother to fix the block, and to use stitch to fix the remaining suture in the Achilles tendon in order to improve the block fixation. The criteria of the AOFAS Foot and Ankle Surgery by the United States Association of ankle-rear foot functional recovery was used to evaluate the Achilles tendon. Total average score was (95.5 +/- 3.12) points, including pain items of(38.5 +/- 2.18) points,the average score of functional items of (49.5 +/- 3.09) points,and power lines of 10 points in all patients. Twenty-one patients got an excellent result, 16 good and 5 poor. The methods of treatment for the calcaneal avulsion fractures with TwinFix suture anchors is a simple operation, and have excellent clinical effect, which is worthy of promotion.
Ratnalingam, Vanitha; Eu, Andrew Lim Keat; Ng, Gim Leong; Taharin, Rohana; John, Elizabeth
To evaluate the recurrence rate, surgical time, and postoperative pain between conjunctival autografting with sutures and with fibrin adhesive in pterygium surgery. A prospective, randomized, double-blind, clinical trial on the benefits of using fibrin adhesive in place of sutures in pterygium surgery. One hundred seventy-five eyes with primary pterygium were randomized to undergo pterygium surgery with conjunctival autograft transplantation using either fibrin adhesive or sutures. One hundred thirty-seven eyes of 113 patients that were operated on by a single surgeon (V.R.) completed the 1-year follow-up. Sixty-eight eyes were operated with fibrin adhesive and 69 eyes with sutures. Patients were followed up at 1 day, 1 week, 1 month, 6 months, and 1 year after surgery. Pterygium recurrence and postoperative pain was graded by an independent observer (A.L.) masked to the method of treatment. Surgical time was measured with a stopwatch. All patients were followed up for 1 year. There were 3 recurrences (4.41%) in the fibrin adhesive group and 11 recurrences (15.9%) in the suture group. The mean duration required to complete surgery in the fibrin adhesive group was 16.93 +/- 2.85 minutes, whereas that of the suture group was 29.84 +/- 5.65 minutes, which was statistically significant (P < 0.001). The immediate postoperative pain score and week 1 postoperative pain score were significantly lower in the fibrin adhesive group (P < 0.05). No major complications were observed in either group. The use of fibrin adhesive in primary pterygium surgery with conjunctival autografts reduces the recurrence rate, surgical time, and postoperative pain when compared with sutures.
Custis, Trenton; Armstrong, April W; King, Thomas H; Sharon, Victoria R; Eisen, Daniel B
Although applying adhesive strips to a wound closure has been shown to have outcomes equivalent to those with cuticular suturing, it is unknown whether adhesive strips provide additional benefit compared with dermal suturing alone. To determine whether the addition of adhesive strips to a wound closed with buried interrupted subcuticular sutures improves outcomes following wound closure. A prospective, randomized split-wound intervention was conducted between November 14, 2013, and May 16, 2014, in patients who underwent cutaneous surgical procedures at the University of California, Davis, outpatient dermatology clinic. Fifty-seven patients 18 years or older with postoperative defects of at least 3 cm, resulting from either Mohs micrographic surgical procedures or surgical excision, were screened for participation. Nine patients were excluded and 48 were enrolled. Half of each wound was randomized to receive buried interrupted subcuticular sutures and overlying adhesive strips and the other half received buried interrupted subcuticular sutures only. At 3 months' follow-up, each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale. The total mean (SD) Patient Observer Scar Assessment Scale score for observers for the side that received a combination of adhesive strips and buried interrupted subcuticular suturing (12.3 [4.8]) and the side that received sutures only (12.9 [6.3]) did not differ significantly at 3 months (P = .32). There was no significant difference in the total patient assessment scale score between the combination closure (14.0 [7.6]) and sutures only (14.7 [7.6]) sides at 3 months (P = .39). There was also no significant difference between the 2 closure methods in terms of mean (SD) scar width (both methods: 1.1 [0.8] mm, P = .89) at follow-up. Combination closure with adhesive strips and buried interrupted subcuticular suturing was not significantly associated with improved overall scar
Wang, Yancheng; Chen, Roland K; Tai, Bruce L; Xu, Kai; Shih, Albert J
This research presents an experimental study evaluating stomach suturing using a precurved nickel-titanium (NiTi) guidewire for an endoscopic minimally invasive obesity treatment. Precise path planning is critical for accurate and effective suturing. A position measurement system utilizing a hand-held magnetic sensor was used to measure the shape of a precurved guidewire and to determine the radius of curvature before and after suturing. Ex vivo stomach suturing experiments using four different guidewire tip designs varying the radius of curvature and bevel angles were conducted. The changes in radius of curvature and suturing force during suturing were measured. A model was developed to predict the guidewire radius of curvature based on the measured suturing force. Results show that a small bevel angle and a large radius of curvature reduce the suturing force and the combination of small bevel angle and small radius of curvature can maintain the shape of guidewire for accurate suturing.
Li, Ye; Ohya, Jun; Chiba, Toshio; Xu, Rong; Yamashita, Hiromasa
Because of the shortage of nurses in the world, the realization of a robotic nurse that can support surgeries autonomously is very important. More specifically, the robotic nurse should be able to autonomously recognize different situations of surgeries so that the robotic nurse can pass necessary surgical tools to the medical doctors in a timely manner. This paper proposes and explores methods that can classify suture and tying actions during suture operations from the video sequence that observes the surgery scene that includes the surgeon's hands. First, the proposed method uses skin pixel detection and foreground extraction to detect the hand area. Then, interest points are randomly chosen from the hand area so that their 3D SIFT descriptors are computed. A word vocabulary is built by applying hierarchical K-means to these descriptors, and the words' frequency histogram, which corresponds to the feature space, is computed. Finally, to classify the actions, either SVM (Support Vector Machine), Nearest Neighbor rule (NN) for the feature space or a method that combines "sliding window" with NN is performed. We collect 53 suture videos and 53 tying videos to build the training set and to test the proposed method experimentally. It turns out that the NN gives higher than 90% accuracies, which are better recognition than SVM. Negative actions, which are different from either suture or tying action, are recognized with quite good accuracies, while "Sliding window" did not show significant improvements for suture and tying and cannot recognize negative actions.
Burks, David; Rosenbury, Sarah B.; Kennelly, Michael J.; Fried, Nathaniel M.
Complications from polypropylene mesh after surgery for female stress urinary incontinence (SUI) may require tedious surgical revision and removal of mesh materials with risk of damage to healthy adjacent tissue. This study explores selective laser vaporization of polypropylene suture/mesh materials commonly used in SUI. A compact, 7 Watt, 647-nm, red diode laser was operated with a radiant exposure of 81 J/cm2, pulse duration of 100 ms, and 1.0-mm-diameter laser spot. The 647-nm wavelength was selected because its absorption by water, hemoglobin, and other major tissue chromophores is low, while polypropylene absorption is high. Laser vaporization of ~200-μm-diameter polypropylene suture/mesh strands, in contact with fresh urinary tissue samples, ex vivo, was performed. Non-contact temperature mapping of the suture/mesh samples with a thermal camera was also conducted. Photoselective vaporization of polypropylene suture and mesh using a single laser pulse was achieved with peak temperatures of 180 and 232 °C, respectively. In control (safety) studies, direct laser irradiation of tissue alone resulted in only a 1 °C temperature increase. Selective laser vaporization of polypropylene suture/mesh materials is feasible without significant thermal damage to tissue. This technique may be useful for SUI procedures requiring surgical revision.
Van Meter, W
PURPOSE: Post operative adjustment of a single continuous suture is an effective means of reducing post keratoplasty astigmatism. This study evaluates post keratoplasty keratometry following suture adjustment with an adjusted suture in place and after the suture is removed. METHODS: Average keratometric astigmatism was measured over 24 months time in 26 patients with an adjusted continuous suture and 24 patients with a continuous suture that was not adjusted. Average keratometry in 43 patients with an adjusted continuous suture was compared with 37 patients with combined continuous and interrupted sutures. Finally, suture out astigmatism in 19 adjusted patients was compared to six patients with no adjustment. RESULTS: There was an increase in average corneal astigmatism over two years of 2.2 diopters in the adjusted group and 1.7 diopters in the non-adjusted group with sutures in place. One year following surgery, average keratometry flattened from 47.5 to 42.9 diopters in the adjusted continuous group and from 47.0 to 46.0 diopters in the group with combined continuous and interrupted sutures. Following suture removal, average astigmatism in patients who had suture adjustment was 4.4 diopters +/- 2.5 diopters (range 1-10 diopters), and 6.01 diopters (range 4-7) in the non-adjusted group. CONCLUSIONS: Average post keratoplasty astigmatism increases after a continuous suture is adjusted but the increase is comparable to patients with acceptable astigmatism who do not require adjustment. More progressive corneal flattening over 12 months time is seen with a continuous suture than which combined sutures. Average suture out astigmatism was 4.0 diopters following suture adjustment, compared to an average of 8.4 diopters prior to adjustment. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 7A FIGURE 7B PMID:8981721
Murphy, B. S.; Egbert, G. D.
We use newly acquired long-period magnetotelluric data to examine lithospheric structure beneath the modern Southern Appalachian Mountains and the adjacent Piedmont. The New York-Alabama Lineament is clearly visible both in inverse models and in the data themselves as a major Appalachian-parallel, mid- to lower-crustal conductive feature. This observation supports geologically-based interpretations of the NY-AL Lineament as a major Grenville suture. We also discern several other suture zones in our inverse models, including the Central Piedmont Suture. Interestingly, we do not observe any geoelectric signature of the Suwannee Suture. Most strikingly, we find a zone of exceptionally high resistivity (>1000 μm) that extends to a depth of more than 200 km beneath the modern Piedmont. This resistive block abuts more conductive lithosphere ( 100 μm, as would be expected for Phanerozoic lithosphere) to the northwest. The boundary between these two distinct domains coincides with the modern Appalachian topographic escarpment to within our resolution. The high resistivity values would seem to require completely dry, highly depleted lithosphere at anomalously cold temperatures; however, corresponding seismically fast lithospheric mantle that would be expected for such a structure has not been observed in any previous studies. The exact nature of this feature therefore remains uncertain at present. Regardless, as it is a persistent feature in inversions and it is also readily apparent in the impedance data, this geoelectric structure likely holds important implications for the past, present, and future tectonic evolution of the Southeastern United States.
Choi, Nam-Hong; Kim, Tae-Hyung; Victoroff, Brian N
There are no reports comparing meniscal healing between inside-out and all-inside repairs using sutures. No difference in healing rate exists between meniscal repairs with inside-out and all-inside suture repair in conjunction with anterior cruciate ligament reconstruction with hamstring tendon. Cohort study; Level of evidence, 2. Forty-eight consecutive patients underwent meniscal repairs of longitudinal tears of the posterior horn of the medial meniscus combined with anterior cruciate ligament reconstructions. All-inside repair was attempted when the tears were located in the red-red zone or the ramp area of the meniscus. If a tear that was in the ramp area or red-red zone extended to the midbody of the meniscus, or if there was a tear in red-white zone, the inside-out repair technique was used. Fourteen patients had all-inside meniscal repairs, and 34 patients had inside-out meniscal repairs with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients. Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm scores, and Tegner activity scales. There was a significant difference in
Nett, Michael; Avelar, Rui; Sheehan, Michael; Cushner, Fred
Standard medial parapatellar arthrotomies of 10 cadaveric knees were closed with either conventional interrupted absorbable sutures (control group, mean of 19.4 sutures) or a single running knotless bidirectional barbed absorbable suture (experimental group). Water-tightness of the arthrotomy closure was compared by simulating a tense hemarthrosis and measuring arthrotomy leakage over 3 minutes. Mean total leakage was 356 mL and 89 mL in the control and experimental groups, respectively (p = 0.027). Using 8 of the 10 knees (4 closed with control sutures, 4 closed with an experimental suture), a tense hemarthrosis was again created, and iatrogenic suture rupture was performed: a proximal suture was cut at 1 minute; a distal suture was cut at 2 minutes. The impact of suture rupture was compared by measuring total arthrotomy leakage over 3 minutes. Mean total leakage was 601 mL and 174 mL in the control and experimental groups, respectively (p = 0.3). In summary, using a cadaveric model, arthrotomies closed with a single bidirectional barbed running suture were statistically significantly more water-tight than those closed using a standard interrupted technique. The sample size was insufficient to determine whether the two closure techniques differed in leakage volume after suture rupture.
Zan, Yiheng; Liu, Hanmin; Zhong, Lin; Qiu, Li; Tao, Qingfen; Chen, Lina
Recurrent pneumonia is defined as more than two episodes of pneumonia in one year or three or more episodes anytime in life. Common clinical scenarios leading to recurrent pneumonia include anatomical abnormalities of respiratory tract, immunodeficiency, congenital heart diseases, primary ciliary dyskinesia, etc. A school-aged girl suffered from 1-2 episodes of pneumonia each year after trachea connection and lung repair operation resulted from an accident of car crash. Bronchoscopy revealed the sutures twisted with granulation in the left main bronchus and the patient's symptoms relieved after removal of the sutures. Here we report for the first time that surgical suture was the cause of recurrent pneumonia. This case indicates that children with late and recurrent onset of pneumonia should undergo detailed evaluation including bronchoscopy.
Abbi, Gaurav; Espinoza, Luis; Odell, Timothy; Mahar, Andrew; Pedowitz, Robert
To compare a standard suture material with a newer material using multiple arthroscopic knot configurations and to evaluate the biomechanical performance of a new sliding-locking knot compared with 4 surgical standards. Controlled laboratory study. Five knots were evaluated (Weston, Tennessee, Duncan, SMC, and the new San Diego knot) using 2 suture materials, No. 2 Ethibond (Ethicon, Somerville, NJ) or No. 2 Fiberwire (Arthrex, Naples, FL). Eight samples were tested for each knot-suture configuration. Samples were pretensioned to 10 N and then loaded from 10 to 45 N for 1,000 cycles. Intact knots were loaded to failure. Fiberwire had significantly higher load-to-failure (276 +/- 24 N) compared with Ethibond (111 +/- 13 N) (P < .001), although there was no significant difference as a function of knot configuration. Of the 40 Fiberwire knots, 3 failed by early slippage during cyclic loading and 8 slipped at very low tension during load-to-failure. None of the Ethibond knots and none of the San Diego knots failed by early slippage. Surface characteristics and suture construction affect the tendency for knot slippage. Surgeons should understand the impact of handling characteristics, frictional properties, and ultimate failure load when selecting suture materials and knots for arthroscopic repair.
Berger, Rachel L; Li, Linda T; Hicks, Stephanie C; Liang, Mike K
Repair of primary ventral hernias (PVH) such as umbilical hernias is a common surgical procedure. There is a paucity of risk-adjusted data comparing suture versus mesh repair of these hernias. We compared preperitoneal polypropylene (PP) repair versus suture repair for elective umbilical hernia repair. A retrospective review of all elective open PVH repairs at a single institution from 2000-2010 was performed. Only patients with suture or PP repair of umbilical hernias were included. Univariate analysis was conducted and propensity for treatment-adjusted multivariate logistic regression. There were 442 elective open PVH repairs performed; 392 met our inclusion criteria. Of these patients, 126 (32.1%) had a PP repair and 266 (67.9%) underwent suture repair. Median (range) follow-up was 60 mo (1-143). Patients who underwent PP repair had more surgical site infections (SSIs; 19.8% versus 7.9%, P < 0.01) and seromas (14.3% versus 4.1%, P < 0.01). There was no difference in recurrence (5.6% versus 7.5%, P = 0.53). On propensity score-adjusted multivariate analysis, we found that body mass index (odds ratio [OR], 1.10) and smoking status (OR, 2.3) were associated with recurrence. Mesh (OR, 2.34) and American Society of Anesthesiologists (OR, 1.95) were associated with SSI. Only mesh (OR, 3.41) was associated with seroma formation. Although there was a trend toward more recurrence with suture repair in our study, this was not statistically significant. Mesh repair was associated with more SSI and seromas. Further prospective randomized controlled trial is needed to clarify the role of suture and mesh repair in PVH. Copyright © 2014 Elsevier Inc. All rights reserved.
Henry, Christopher R; Flynn, Harry W; Miller, Darlene; Schefler, Amy C; Forster, Richard K; Alfonso, Eduardo C
The purpose of the current study was to report the microbiology, risk factors, and treatment outcomes in patients with delayed-onset endophthalmitis associated with corneal suture infections. For this retrospective consecutive case series, a search of the ocular microbiology department database was performed to identify all patients with positive corneal and intraocular cultures (anterior chamber and/or vitreous) between 01 January 1995 and 01 January 2010. A subset of patients with a history of corneal suture infections and delayed-onset endophthalmitis was identified. Over the 15-year period of the study, 68 patients were identified to have both positive corneal and intraocular cultures. Among them, six patients were identified to have a culture-proven, delayed-onset endophthalmitis that developed from a culture-positive corneal suture infection. All of the patients in the current study were using topical corticosteroids at the time of diagnosis. In four of six patients, there was documented manipulation of a suture before the development of endophthalmitis. Streptoccocus was identified as the causative organism in five of six patients in the current study. All of the Streptoccocus isolates were sensitive to vancomycin. The single case of Serratia marcescens endophthalmitis was sensitive to amikacin, ceftazidime, ciprofloxacin, gentamicin, and tobramycin. Treatment modalities varied and were guided by the attending ophthalmologist depending upon clinical presentation. One patient with severe Streptococcus pyogenes keratitis and endophthalmitis underwent a primary enucleation after developing a wound dehiscence. Of the remaining five patients, all received topical and intravitreal antibiotics. Therapeutic penetrating keratoplasty was performed in three patients. Pars plana vitrectomy was performed in two patients. Visual acuity outcomes ranged from 20/150 to no light perception. In the current study, Streptococcus was isolated in nearly all patients with delayed
Sánchez-Vicente, J L; Rueda-Rueda, T; González-García, M L; López-Herrero, F; Sánchez-Vicente, P; Castilla-Lázpita, A
We present the case of an 81-year-old man with retinal detachment caused by intrusion of an Arruga suture. The encircling buckle was located in the sub-retinal space and caused retinal breaks with retinal detachment A pars plana vitrectomy was performed along with intraocular cutting of the Arruga suture with retinal re-attachment. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Liu, Lei; Jiang, Yunyao; Boyce, Mary; Ortiz, Christine; Baur, Jeffery; Song, Juha; Li, Yaning
Irregular interdigitated morphology is prevalent in biological sutures in nature. Suture complexity index has long been recognized as the most important morphological parameter to govern the mechanical properties of biological sutures. However, the suture complexity index alone does not reflect all aspects of suture morphology. The goal of this investigation was to determine that besides suture complexity index, whether the degree of morphological irregularity of biological sutures has influences on the mechanical properties, and if there is any, how to quantify these influences. To explore these issues, theoretical and finite element (FE) suture models with the same suture complexity index but different levels of morphological irregularity were developed. The quasi-static stiffness, strength for damage initiation and post-failure process of irregular sutures were studied. It was shown that for the same suture complexity index, when the level of morphological irregularity increases, the overall strain to failure will increase while tensile stiffness is retained; also, the total energy to fracture increases with a sacrifice in strength to damage initiation. These results reveal that morphological irregularity is another important independent parameter to govern and balance the mechanical properties of biological sutures. Therefore, from the mechanics point of view, the prevalence of irregular suture morphology in nature is a merit, not a defect. Copyright © 2017 Elsevier Ltd. All rights reserved.
Choi, Nam-Hong; Kim, Byeong-Yeon; Hwang Bo, Byung-Hun; Victoroff, Brian N
To compare meniscal healing and functional outcomes after all-inside meniscal repair between sutures and meniscal fixation devices. Sixty patients with a tear within the red-red or red-white zones of the posterior horn of the medial or lateral meniscus in conjunction with an anterior cruciate ligament (ACL) tear were included in this study. Meniscal repairs were performed with sutures in 35 patients and the FasT-Fix device (Smith & Nephew Endoscopy, Andover, MA) in 25 patients concomitantly with hamstring ACL reconstruction. Postoperative evaluations included Lysholm knee score, Tegner activity scale, Lachman and pivot-shift tests, and KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. Follow-up magnetic resonance imaging (MRI) scans were obtained postoperatively for all patients to evaluate meniscal healing. The mean follow-up period was 47.2 months. In the suture group, 31 patients (86.1%) were asymptomatic and 4 (13.9%) were symptomatic. In the FasT-Fix group, 20 patients (80%) were asymptomatic and 5 (20%) were symptomatic. Postoperative functional evaluation and knee stability showed no statistically significant difference between the 2 groups. Follow-up MRI showed that 26 menisci (74.3%) were healed, 3 menisci (8.6%) were partially healed, and 6 menisci (17.1%) were not healed in the suture group. In the FasT-Fix group, 15 menisci (64%) were healed, 7 menisci (24%) were partially healed, and 3 menisci (12%) were not healed. Follow-up MRI showed no statistically significant difference between the 2 groups. In the FasT-Fix group, follow-up MRI showed a newly developed cyst posterior to the medial meniscus in 2 patients. A new tear anterior to the previous tear was found in 1 patient. In the suture group, follow-up MRI showed no cysts or new tears. All-inside meniscal repairs using either sutures or the FasT-Fix device showed satisfactory results in patients with concomitant hamstring ACL reconstruction. There was no statistically significant difference in
Zhang, Peng; Chen, TianWu; Chen, ShiYi
Purpose. To compare the biomechanical properties of 3 suture-bridge techniques for rotator cuff repair. Methods. Twelve pair-matched fresh-frozen shoulder specimens were randomized to 3 groups of different repair types: the medially Knotted Suture Bridge (KSB), the medially Untied Suture Bridge (USB), and the Modified Suture Bridge (MSB). Cyclic loading and load-to-failure test were performed. Parameters of elongation, stiffness, load at failure, and mode of failure were recorded. Results. The MSB technique had the significantly greatest load to failure (515.6 ± 78.0 N, P = 0.04 for KSB group; P < 0.001 for USB group), stiffness (58.0 ± 10.7 N/mm, P = 0.005 for KSB group; P < 0.001 for USB group), and lowest elongation (1.49 ± 0.39 mm, P = 0.009 for KSB group; P = 0.001 for USB group) among 3 groups. The KSB repair had significantly higher ultimate load (443.5 ± 65.0 N) than USB repair (363.5 ± 52.3 N, P = 0.024). However, there was no statistical difference in stiffness and elongation between KSB and USB technique (P = 0.396 for stiffness and P = 0.242 for elongation, resp.). The failure mode for all specimens was suture pulling through the cuff tendon. Conclusions. Our modified suture bridge technique (MSB) may provide enhanced biomechanical properties when compared with medially knotted or knotless repair. Clinical Relevance. Our modified technique may represent a promising alternative in arthroscopic rotator cuff repair. PMID:27975065
Stewart, D W; Buffington, P J; Wacksman, J
A comparison of polydioxanone, polyglactin, and chromic catgut suture was performed in 120 rat bladders studying propensity for infection, degree of inflammation, calculogenic potential, changes in urine pH, and suture absorption. None of the sutures predisposed to infection and there was wide variability but no correlation in urine pH. Although initially the polydioxanone incited a greater inflammatory response, by six months all three sutures were similar. The absorption of polydioxanone was slower than chromic catgut suture, but similar to the absorption of polyglactin. There was no significant difference in calculogenic potential between the suture materials tested over a six-month period. Based on this study in rats, polydioxanone suture would appear to be equal to catgut and polyglactin suture in bladder surgery.
Zhao, Jie; Liu, Zhixiong; Liu, Yunsheng; Liu, Jinfang; Fang, Wenhua; Rao, Yihua; Yang, Liang; Yuan, Xianrui
To evaluate the efficacy of dural tenting suture and epidural drainage in craniotomy. In 145 cases of intracranial lesions, dural tenting suture and epidural drainage were performed to prevent epidural hematoma. Postoperative computed tomography (CT) showed no epidural hematoma required surgery in both groups. Both dural tenting suture and epidural drainage are effective in preventing epidural hematoma. Hemostasis is the key step. Dural tenting suture without epidural drainage relieves psychological stress. It decreases the risk of intracranial infection and avoids some unusual complications.
Lambrechts, Mark; Nazari, Behrooz; Dini, Arash; O'Brien, Michael J.; Heard, Wendell M. R.; Savoie, Felix H.; You, Zongbing
Purpose: The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction. Materials and Methods: Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord™ suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire® suture (FiberWire®, Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper. Results: The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord™ suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire® suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student's t-test, which showed significance between Orthocord™ and FiberWire® sutures (P = 0.026), but not significant between Orthocord™ and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire® sutures (P = 0.103). Conclusion: The cheese-wiring effect is less in the Orthocord™ suture than in the FiberWire® suture in human cadaveric supraspinatus tendons. Clinical Relevance: Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection. PMID:25258499
Krishnan, R; Izadi, S; Morton, C E; Marsh, I B
Frost sutures are temporary suspension sutures conventionally used in oculoplastics. The case is presented here of a patient with multiple orbital fractures who developed worsening conjunctival chemosis and pseudoproptosis. This patient was managed successfully with Frost sutures. To the best of the authors' knowledge, there is no documented use of Frost sutures in this type of case. It is emphasized that this technique should only be considered following rigorous exclusion of retrobulbar pathology and careful attention towards early detection of raised intraocular pressure.
Suzuki, Takashi; Iihara, Hirotoshi; Uno, Toshihiko; Hara, Yuko; Ohkusu, Kiyofumi; Hata, Hiroyuki; Shudo, Masachika; Ohashi, Yuichi
We report two cases of suture-related keratitis following penetrating keratoplasty. In both cases, Corynebacterium macginleyi was isolated from corneal specimens. Scanning electron microscopy revealed that corynebacteria could aggregate and form a biofilm. The MICs of sulbenicillin and fluoroquinolones were high for both isolates. Our findings show that C. macginleyi can cause keratitis with biofilm formation. PMID:17913935
Boogerd, W; Zoetmulder, F A; Moffie, D
A patient is described with a severe encephalopathy and hyperammonemia in absence of liver dysfunction, attributed to urine absorption into the systemic circulation due to suture line breakdown after bladder dome resection. At autopsy characteristic Alzheimer type II astrocytes were found in the basal ganglia.
Knutson, Cassandra M.; Schneiderman, Deborah K.; Yu, Ming; Javner, Cassidy H.; Distefano, Mark D.; Wissinger, Jane E.
With new K-12 national science standards emerging, there is an increased need for experiments that integrate engineering into the context of society. Here we describe a chemistry experiment that combines science and engineering principles while introducing basic polymer and green chemistry concepts. Using medical sutures as a platform for…
Ahn, Janice Seulgy; Grise, Joy; DelTondo, Joseph A
Endogenous pulmonary thromboemboli are a common cause of noncardiac sudden natural death. Embolism of exogenous material is a rare but potential finding in autopsies following surgeries, medical procedures, penetrating trauma, and nonparenteral drug abuse. This report describes the first case of a suture embolism of the left superior lobar pulmonary artery following complicated abdominal surgery. © 2018 American Academy of Forensic Sciences.
Chang, H. N.; Garetto, L. P.; Potter, R. H.; Katona, T. R.; Lee, C. H.; Roberts, W. E.
The purpose of this study was to examine the angiogenic and the subsequent osteogenic responses during a 96-hour time-course after sutural expansion. Fifty rats were divided into: (1) a control group that received only angiogenic induction through injection of 5 ng/gm recombinant human endothelial cell growth factor (rhECGF); (2) an experimental group that received orthopedic expansion and rhECGF; (3) a sham group that received expansion and sodium chloride (NaCl) injection; and (4) a baseline group that received no expansion or injection. All rats were injected with 3H-thymidine (1.0 microCi/gm) 1 hour before death to label the DNA of S-phase cells. Demineralized sections (4 microm thick) were stained with hematoxylin and eosin. Angiogenesis and cell migration were analyzed with a previously established cell kinetics model. Analysis of variance was used to test the hypothesis that enhancement of angiogenesis stimulates reestablishment of osteogenic capability. Blood vessel number, area, and endothelial cell-labeled index significantly increased in experimental groups, but no difference was found between control and baseline groups. Labeled-pericyte index and activated pericyte numbers in the experimental group were also higher than in the sham groups. These results show that supplemental rhECGF enhances angiogenesis in expanded sutures but not in nonexpanded sutures. Data also suggest that pericytes are the source of osteoblasts in an orthopedically expanded suture.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Industry and FDA.” See § 878.1(e) for the availability of this guidance document. [56 FR 24685, May 31...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable polydioxanone surgical suture. 878.4840 Section 878.4840 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Industry and FDA.” See § 878.1(e) for the availability of this guidance document. [67 FR 77676, Dec. 19...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable expanded polytetrafluoroethylene surgical suture. 878.5035 Section 878.5035 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF...; Guidance for Industry and FDA.” See § 878.1(e) for the availability of this guidance document. [65 FR 20735...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5020 Nonabsorbable...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5010...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5010...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830 Absorbable...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5020 Nonabsorbable...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5020 Nonabsorbable...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5010...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonabsorbable polyamide surgical suture. 878.5020 Section 878.5020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5020 Nonabsorbable...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830 Absorbable...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830 Absorbable...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nonabsorbable polypropylene surgical suture. 878.5010 Section 878.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.5010...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Absorbable surgical gut suture. 878.4830 Section 878.4830 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4830 Absorbable...
These are established primarily to reduce the accidental spread of hazardous substances by workers or equipment from contaminated areas to clean areas. They include the exclusion (hot) zone, contamination reduction (warm) zone, and support (cold) zone.
Hou, Bo; Fukai, Naomi; Olsen, Bjorn R
Mechanical stress is an important epigenetic factor for regulating skeletal remodeling, and application of force can lead to remodeling of both bone and cartilage. Chondrocytes, osteoblasts and osteoclasts all participate and interact with each other in this remodeling process. To study cellular responses to mechanical stimuli in a system that can be genetically manipulated, we used mouse midpalatal suture expansion in vivo. Six-week-old male C57BL/6 mice were subjected to palatal suture expansion by opening loops with an initial force of 0.56 N for the periods of 1, 3, 5, 7, 14 or 28 days. Periosteal cells in expanding sutures showed increased proliferation, with Ki67-positive cells representing 1.8+/-0.1% to 4.5+/-0.4% of total suture cells in control groups and 12.0+/-2.6% to 19.9+/-1.2% in experimental/expansion groups (p<0.05). Starting at day 1, cells expressing alkaline phosphatase and type I collagen were seen. New cartilage and bone formation was observed at the oral edges of the palatal bones at day 7; at the nasal edges only bone formation without cartilage appeared to occur. An increase in osteoclast numbers suggested increased bone remodeling, ranging from 60 to 160% throughout the experimental period. Decreased Saffranin O staining after day 3 suggested decreased proteoglycan content in the secondary cartilage. Micro-CT showed a significant increase in maxillary width at days 14 and 28 (from 2334+/-4 microm to 2485+/-3 microm at day 14 and from 2383+/-5 microm to 2574+/-7 microm at day 28, p<0.001). The suture width was increased at days 14 and 28, except in the oral third region at day 28 (from 48+/-5 microm to 36+/-4 microm, p<0.05). Bone volume/total volume was significantly reduced at days 14 and 28 (50.2+/-0.7% vs. 68.0+/-3.7% and 56.5+/-1.0% vs. 60.9+/-1.3%, respectively, p<0.05), indicative of increased bone marrow space. These findings demonstrate that expansion forces across the midpalatal suture promote bone resorption through activation of
Hou, Bo; Fukai, Naomi; Olsen, Bjorn R.
Mechanical stress is an important epigenetic factor for regulating skeletal remodeling, and application of force can lead to remodeling of both bone and cartilage. Chondrocytes, osteoblasts and osteoclasts all participate and interact with each other in this remodeling process. To study cellular responses to mechanical stimuli in a system that can be genetically manipulated, we used mouse midpalatal suture expansion in vivo. 6-weeks-old male C57BL/6 mice were subjected to palatal suture expansion by opening loops with an initial force of 0.56N for periods of 1, 3, 7, 14 or 28 days. Periosteal cells in expanding sutures showed increased proliferation, with Ki67 positive cells representing 1.8±0.1% to 4.5±0.4% of total suture cells in control groups and 12.0±2.6% to 19.9±1.2% in experimental/expansion groups (p<0.05). Starting at day 1, cells expressing alkaline phosphatase and type I collagen were seen. New cartilage and bone formation was observed at the oral edges of the palatal bones at day 7; at the nasal edges only bone formation without cartilage appeared to occur. An increase in osteoclast numbers suggested increased bone remodeling, ranging from 60 to 160% throughout the experimental period. Decreased Saffranin O staining after day 3 suggested decreased proteoglycan content in the secondary cartilage. MicroCT showed a significant increase in maxillary width at days 14 and 28 (from 2334±4μm to 2485±3μm at day 14 and from 2383±5μm to 2574±7μm at day 28, p<0.001). The suture width was increased at days 14 and 28, except in the oral third region at day 28 (from 48±5μm to 36±4μm, p<0.05). Bone volume/total volume was significantly reduced at days 14 and 28 (50.2±0.7% vs. 68.0±3.7% and 56.5±1.0%vs. 60.9±1.3%, respectively, p<0.05), indicative of increased bone marrow space. These findings demonstrate that expansion forces across the midpalatal suture promote bone resorption through activation of osteoclasts and bone and cartilage formation via
Li, Haidong; Song, Tao
To introduce nickel-titanium wire as suture material for closure of incisions in cleft lip procedures. Closure of skin incisions using nickel-titanium wire as suture material, with postoperative follow-up wound evaluation. There was excellent patient satisfaction and good cosmetic outcome. Nickel-titanium wire is an excellent alternative for suture closure of cleft lip surgical incisions.
Baykal, Bahadir; Erdim, Ibrahim; Guvey, Ali; Oghan, Fatih; Kayhan, Fatma Tulin
To rotate the nasal axis and septum to the midline using an L-strut graft and a novel caudal septal stabilization suturing technique to treat crooked noses. Thirty-six patients were included in the study. First, an L-strut graft was prepared by excising the deviated cartilage site in all patients. Second, multiple stabilization suturing, which we describe as a caudal septal stabilization suturing technique with a "fishing net"-like appearance, was applied between the anterior nasal spine and caudal septum in all patients. This new surgical technique, used to rotate the caudal septum, was applied to 22 I-type and 14 C-type crooked noses. Correction rates for the crooked noses were compared between the 2 inclination types with angular estimations. Deviation angles were measured using the AutoCAD 2012 software package and frontal (anterior) views, with the Frankfurt horizontal line parallel to the ground. Nasal axis angles showing angle improvement graded 4 categories as excellent, good, acceptable, and unsuccessful for evaluations at 6 months after surgery in the study. The success rate in the C-type nasal inclination was 86.7% (±21.9) and 88% (±16.7) in the I-type. The overall success rate of L-strut grafting and caudal septal stabilization suturing in crooked nose surgeries was 87.5% (±18.6). "Unsuccessful" results were not reported in any of the patients. L-strut grafting and caudal septal stabilization suturing techniques are efficacious in crooked noses according to objective measurement analysis results. However, a longer follow-up duration in a larger patient population is needed.
Légner, András; Tsuboi, Kazuto; Stadlhuber, Rudolf; Yano, Fumiaki; Halvax, Peter; Hunt, Brandon; Penka, Wayne; Filipi, Charles J
Suture and staple-based endoluminal devices for gastroesophageal reflux disease (GERD) and obesity have failed to demonstrate long-term efficacy. To demonstrate the feasibility of mucosal excision and full-thickness suture apposition of the excision beds to create sufficient scar tissue formation at the gastroesophageal junction for the intraluminal treatment of GERD or obesity. Survival animal experiments. Seven mongrel dogs. Interventions. Under general endotracheal anesthesia, a Barostat test was performed on 4 dogs. A mucosal excision device was introduced through the esophagus into the proximal stomach. Two to 4 mucosal excisions were performed on all dogs at or just below the gastroesophageal junction and the mucosal pieces were removed. After hemostasis, an intraluminal suturing instrument was introduced and either 2 or 4 sutures were placed through the excision beds to bring them into apposition. These were tied and the suture strands cut. All dogs were survived for 2 months. End-term endoscopies were performed, and a repeat Barostat procedure was performed on the animals undergoing an antireflux procedure. After euthanasia the stomachs were explanted, examined, photographed, and sectioned for histologic examination. All dogs survived without complication. In the 4 GERD dogs, the Barostat studies demonstrated a significant decrease in gastroesophageal junction compliance. In the 3 dogs undergoing the obesity procedure, the gastric outlet apposition to a 6-mm endoscope was satisfactory with full insufflation and the desired scarring was seen on histologic examination. It is possible to create adequate gastroesophageal junction scarring for the treatment of GERD and obesity. A clinical pilot study will be initiated.
Wang, Xu; Ma, Xin; Zhang, Chao; Wang, Chen; Huang, Jia-zhang
To explore the efficacy of overlapping suture-anchor fixation for treatment of chronic deltoid ligament injury. Seventeen patients (11 men, 6 women of mean age 32.1 years [range, 18-58 years]) who had undergone surgery for chronic deltoid ligament injury from January 2007 to December 2011 were retrospectively analyzed. Preoperatively, they had undergone bilateral weight-bearing posterior-anterior radiographs, (MRI) and ultrasound examinations of the ankle. Ankle arthroscopy was performed to confirm the diagnosis, followed by surgery to clear intra-articular proliferating synovial tissues and remove cartilage debris and scar tissue. The deep layer of the deltoid ligament was sutured onto the tip of the medial malleolus and its superficial layer sutured onto its periosteum and fixed with suture anchors. American Orthopedic Foot and Ankle Society (AOFAS) scoring system for the ankle-hindfoot was used to evaluate the ankles pre- and post-operatively. The 17 patients were followed up for 12-34 months (mean 20.1 months). The angle between the long axes of the talus and first metatarsal and the hindfoot angle measured in a hindfoot alignment view (as described by Saltzman) were reduced from 5.4° ± 1.8° and 8.2° ± 2.6° preoperatively to 4.0° ± 0.9° and 5.3° ± 1.3° postoperatively, respectively. The mean AOFAS ankle-hindfoot score was 76.8 ± 7.0 preoperatively and 94.1 ± 3.3 at the last follow-up visit. Ten patients were scored as excellent, six as good, and one as fair. Pain was relieved in all patients and no patients had recurrent deltoid ligament injury. Using suture anchors to treat chronic deltoid ligament injury has relatively satisfactory outcomes. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.
Wang, Jingwei; Hua, Yinghui; Chen, Shiyi; Li, Hongyun; Zhang, Jian; Li, Yunxia
Arthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique. We performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score. After reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases. Studies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future. Level
Kapp, P. A.; Ding, L.
The India-Asia collision zone is widely pointed to as the type Cenozoic example of continental suturing and collision, yet there remains considerable controversy about its geological and geodynamical evolution. This in part may reflect the richness and complexity of the geological records exposed across the collision zone and how much remains to be extracted from them. Separating the formerly Andean-style continental margin of southern Asia (Gangdese arc and forearc of the Lhasa terrane) in the north, from Indian-affinity strata deformed in the Tethyan Himalayan thrust belt to the south, is the Indus-Yarlung suture zone (IYSZ). In Tibet, ophiolitic rocks along the IYSZ crystallized and were obducted in a suprasubduction zone setting during Early Cretaceous time. The ophiolitic rocks are of the appropriate age to have formed the basement upon which Gangdese forearc strata accumulated. Alternatively, they may represent remnants of an intra-oceanic subduction system that persisted in the Tethys, far from Asia, until Greater India collided with it during the latest Cretaceous to Paleocene. There has been no documentation, however, of ophiolitic or arc fragments younger than Early Cretaceous within the IYSZ. Distinguishing between these two end-member scenarios is important for interpreting detrital records of orogenesis and seismic tomographic images of the mantle. A preponderance of evidence suggests that collision between the Tethyan Himalaya and Asia initiated by 52 Ma. Initial collision led abruptly to profound and far-field changes in paleogeography and tectonism such that by 45 Ma, major shortening and potassic volcanism was ongoing in northern Tibet, plateau-like conditions were established in central Tibet, Tethyan Himalayan crust was undergoing anatexis, and Eo-Himalayan prograde metamorphism was underway. Additional constraints on the shortening history of the Tethyan Himalayan thrust belt will be key to assessing when and how much Greater Indian lithosphere
Wang, Erchie; Kamp, Peter J. J.; Xu, Ganqing; Hodges, Kip V.; Meng, Kai; Chen, Lin; Wang, Gang; Luo, Hui
The highest elevation of the Tibetan Plateau, lying 5,700 m above sea level, occurs within the part of the Lhasa block immediately north of the India-Tibet suture zone (Yarlung Zangbo suture zone, YZSZ), being 700 m higher than the maximum elevation of more northern parts of the plateau. Various mechanisms have been proposed to explain this differentially higher topography and the rock uplift that led to it, invoking crustal compression or extension. Here we present the results of structural investigations along the length of the high elevation belt and suture zone, which rather indicate flexural bending of the southern margin of the Lhasa block (Gangdese magmatic belt) and occurrence of an adjacent foreland basin (Kailas Basin), both elements resulting from supra-crustal loading of the Lhasa block by the Zangbo Complex (Indian plate rocks) via the Great Counter Thrust. Hence we interpret the differential elevation of the southern margin of the plateau as due originally to uplift of a forebulge in a retro foreland setting modified by subsequent processes. Identification of this flexural deformation has implications for early evolution of the India-Tibet continental collision zone, implying an initial (Late Oligocene) symmetrical architecture that subsequently transitioned into the present asymmetrical wedge architecture. PMID:26174578
Thiede, A; Troidl, H; Poser, H; Jostarndt, L; Hamelmann, H
The increasing use of auto-suture staplers for gastrointestinal anastomoses makes it necessary to test the value of this new method of suturing. In a "pilot study" the practicability, the tightness and permeability of the anastomosis and complications were tested and analysed in a total of 30 colon and rectal anastomoses using the EEA-suture gun. The results of 14 colon resections and 16 low anterior resections justify the further use of the EEA auto-suture apparatus and raise the question of a prospective controlled random study in which manual and mechanical machine sutured anastomoses are compared.
Liu, Sean Shih-Yao; Xu, Haisong; Sun, Jun; Kontogiorgos, Elias; Whittington, Patrick R; Misner, Kenner G; Kyung, Hee-Moon; Buschang, Peter H; Opperman, Lynne A
Suture expansion stimulates bone growth to correct craniofacial deficiencies but has a high potential of treatment relapse. The objective of this study was to investigate whether there is a dose-dependent relationship between the recombinant human bone morphogenetic protein-2 (rhBMP-2) and bone formation during suture expansion. Fifty 6-week-old male New Zealand white rabbits were randomly assigned to 5 groups to receive 0 (control), 0.01, 0.025, 0.1, or 0.4 mg/mL of rhBMP-2 delivered by absorbable collagen sponge placed over the interfrontal suture. The suture was expanded for 33 days by 200 g of constant force via a spring anchored with 2 miniscrew implants. Distance of suture expansion, suture volume, and cross-sectional area after expansion were measured using radiographs with bone markers and microcomputed tomography. Suture widths and mineralization appositional rates were calculated based on the widths between bone labels under an epifluorescent microscope. Software (Multilevel Win 2.0; University of Bristol, Bristol, United Kingdom) was used to model distance of suture expansion over time as polynomials to compare group differences. Wilcoxon signed rank tests were performed to compare the suture volume and cross-sectional area, mineral apposition rate, and suture width between groups. The significance level was set at P = 0.05. Whereas the sutures were expanded in all groups, sutures were expanded by significantly greater amounts in the control and the 0.01 mg/mL groups without fusing the sutures than in the 0.025, 0.1, and 0.4 mg/mL groups with fusing sutures. Compared with the controls, the 0.01 mg/mL group showed significantly lower suture volumes, cross-sectional areas, and suture widths after expansion. The mineral apposition rate was significantly higher in the 0.01 mg/mL group than in the controls from days 10 to 30. The 0.01 mg/mL dose of rhBMP-2 delivered by absorbable collagen sponge can stimulate bone formation at the bony edges of the suture
Background Approximately 70% of women will experience some degree of perineal trauma following vaginal delivery and will require stitches. This may result in perineal pain and superficial dyspareunia. Objectives The objective of this review was to assess the effects of absorbable synthetic suture material as compared with catgut on the amount of short and long term pain experienced by mothers following perineal repair. Search strategy We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register. Selection criteria Randomised trials comparing absorbable synthetic (polyglycolic acid and polyglactin) with plain or chromic catgut suture for perineal repair in mothers after vaginal delivery. Data collection and analysis Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer. Main results Eight trials were included. Compared with catgut, the polyglycolic acid and polyglactin groups were associated with less pain in first three days (odds ratio 0.62, 95% confidence interval 0.54 to 0.71). There was also less need for analgesia (odds ratio 0.63, 95% confidence interval 0.52 to 0.77) and less suture dehiscence (odds ratio 0.45, 95% confidence interval 0.29 to 0.70). There was no significant difference in long term pain (odds ratio 0.81, 95% confidence interval 0.61 to 1.08). Removal of suture material was significantly more common in the polyglycolic acid and polyglactin groups (odds ratio 2.01, 95% confidence interval 1.56 to 2.58). There was no difference in the amount of dyspareunia experienced by women. Authors’ conclusions Absorbable synthetic suture material (in the form of polyglycolic acid and polyglactin sutures) for perineal repair following childbirth appears to decrease women’s experience of short-term pain. The length of time taken for the synthetic material to be absorbed is of concern. A trial addressing the use of polyglactin has recently been completed and this has
Zhang, Gangqiang; Ren, Tianhui; Lette, Walter; Zeng, Xiangqiong; van der Heide, Emile
Nowadays there is a wide variety of surgical sutures available in the market. Surgical sutures have different sizes, structures, materials and coatings, whereas they are being used for various surgeries. The frictional performances of surgical sutures have been found to play a vital role in their functionality. The high friction force of surgical sutures in the suturing process may cause inflammation and pain to the person, leading to a longer recovery time, and the second trauma of soft or fragile tissue. Thus, the investigation into the frictional performance of surgical suture is essential. Despite the unquestionable fact, little is actually known on the friction performances of surgical suture-tissue due to the lack of appropriate test equipment. This study presents a new penetration friction apparatus (PFA) that allowed for the evaluation of the friction performances of various surgical needles and sutures during the suturing process, under different contact conditions. It considered the deformation of tissue and can realize the puncture force measurements of surgical needles as well as the friction force of surgical sutures. The developed PFA could accurately evaluate and understand the frictional behaviour of surgical suture-tissue in the simulating clinical conditions. The forces measured by the PFA showed the same trend as that reported in literatures. Copyright © 2017 Elsevier Ltd. All rights reserved.
Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I
Research has shown that Pan and Homo have similar ectocranial suture synostosis patterns and a similar suture ontogeny (relative timing of suture fusion during the species ontogeny). This ontogeny includes patency during and after neurocranial expansion with a delayed bony response associated with adaptation to biomechanical forces generated by mastication. Here we investigate these relationships for Gorilla by examining the association among ectocranial suture morphology, cranial volume (as a proxy for neurocranial expansion) and dental development (as a proxy for the length of time that it has been masticating hard foods and exerting such strains on the cranial vault) in a large sample of Gorilla gorilla skulls. Two-hundred and fifty-five Gorilla gorilla skulls were examined for ectocranial suture closure status, cranial volume and dental eruption. Regression models were calculated for cranial volumes by suture activity, and Kendall's tau (a non-parametric measure of association) was calculated for dental eruption status by suture activity. Results suggest that, as reported for Pan and Homo, neurocranial expansion precedes suture synostosis activity. Here, Gorilla was shown to have a strong relationship between dental development and suture activity (synostosis). These data are suggestive of suture fusion extending further into ontogeny than brain expansion, similar to Homo and Pan. This finding allows for the possibility that masticatory forces influence ectocranial suture morphology. © 2011 The Authors. Journal of Anatomy © 2011 Anatomical Society of Great Britain and Ireland.
Cray, James; Cooper, Gregory M; Mooney, Mark P; Siegel, Michael I
Research has shown that Pan and Homo have similar ectocranial suture synostosis patterns and a similar suture ontogeny (relative timing of suture fusion during the species ontogeny). This ontogeny includes patency during and after neurocranial expansion with a delayed bony response associated with adaptation to biomechanical forces generated by mastication. Here we investigate these relationships for Gorilla by examining the association among ectocranial suture morphology, cranial volume (as a proxy for neurocranial expansion) and dental development (as a proxy for the length of time that it has been masticating hard foods and exerting such strains on the cranial vault) in a large sample of Gorilla gorilla skulls. Two-hundred and fifty-five Gorilla gorilla skulls were examined for ectocranial suture closure status, cranial volume and dental eruption. Regression models were calculated for cranial volumes by suture activity, and Kendall's tau (a non-parametric measure of association) was calculated for dental eruption status by suture activity. Results suggest that, as reported for Pan and Homo, neurocranial expansion precedes suture synostosis activity. Here, Gorilla was shown to have a strong relationship between dental development and suture activity (synostosis). These data are suggestive of suture fusion extending further into ontogeny than brain expansion, similar to Homo and Pan. This finding allows for the possibility that masticatory forces influence ectocranial suture morphology. PMID:21385182
Shibazaki-Yorozuya, Reiko; Wang, Qian; Dechow, Paul C; Maki, Koutaro; Opperman, Lynne A
Craniofacial sutures are bone growth fronts that respond and adapt to biomechanical environments. Little is known of the role sutures play in regulating the skull biomechanical environment during patency and fusion conditions, especially how delayed or premature suture fusion will impact skull biomechanics. Tgf-β3 has been shown to prevent or delay suture fusion over the short term in rat skulls, yet the long-term patency or its consequences in treated sutures is not known. It was therefore hypothesized that Tgf-β3 had a long-term impact to prevent suture fusion and thus alter the skull biomechanics. In this study, collagen gels containing 3 ng Tgf-β3 were surgically placed superficial to the posterior interfrontal suture (IFS) and deep to the periosteum in postnatal day 9 (P9) rats. At P9, P24, and P70, biting forces and strains over left parietal bone, posterior IFS, and sagittal suture were measured with masticatory muscles bilaterally stimulated, after which the rats were sacrificed and suture patency analyzed histologically. Results demonstrated that Tgf-β3 treated sutures showed less fusion over time than control groups, and strain patterns in the skulls of the Tgf-β3-treated group were different from that of the control group. Although bite force increased with age, no alterations in bite force were attributable to Tgf-β3 treatment. These findings suggest that the continued presence of patent sutures can affect strain patterns, perhaps when higher bite forces are present as in adult animals. Copyright © 2012 Wiley Periodicals, Inc.
Kim, Jae-Hwa; Chung, Ju-Hwan; Lee, Dong-Hoon; Lee, Yoon-Seok; Kim, Jung-Ryul; Ryu, Keun-Jung
To evaluate functional and radiographic results of arthroscopic suture anchor repair for posterior root tear of the medial meniscus (PRTMM) and compare with pullout suture repair. From December 2006 to August 2008, 51 consecutive patients underwent arthroscopic repair of PRTMM at our hospital. The repair technique was switched over time from pullout suture repair (group 1) to suture anchor repair (group 2). Of the patients, 6 were lost to follow-up, leaving a study population of 45 patients, with 22 menisci (48.9%) in group 1 and 23 (51.1%) menisci in group 2. The mean follow-up duration was 25.9 months (range, 24 to 27 months) in group 1 and 26.8 months (range, 24 to 28 months) in group 2. Compared variables included International Knee Documentation Committee criteria, Kellgren-Lawrence grade, gap distance at PRTMM, structural healing, meniscal extrusion, and cartilage degeneration of the medial femoral condyle. At 2 years postoperatively, both groups showed significant improvements in function (P < .05) and did not show significant differences in Kellgren-Lawrence grade (P > .05) compared with preoperatively. On magnetic resonance imaging, the gap distance at PRTMM was 3.2 ± 1.1 mm in group 1 and 2.9 ± 0.9 mm in group 2 preoperatively (P > .05). Complete structural healing was seen in 11 cases in group 1 and 12 cases in group 2 (P > .05). Mean meniscal extrusion of 4.3 ± 0.9 mm (group 1) and 4.1 ± 1.0 mm (group 2) preoperatively was significantly decreased to 2.1 ± 1.0 mm (group 1) and 2.2 ± 0.8 mm (group 2) postoperatively (P < .05). Regardless of repair technique, incompletely healed cases showed progression of cartilage degeneration (4 cases in group 1 and 2 cases in group 2). For PRTMM, our results show significant functional improvement in both the suture anchor repair and pullout suture repair groups. Reduction of meniscal extrusion seems to be appropriate to preserve its protective role against progression of cartilage degeneration after complete
Schweitzer, T; Böhm, H; Meyer-Marcotty, P; Collmann, H; Ernestus, R-I; Krauß, J
During the last decades, computed tomography (CT) has become the predominant imaging technique in the diagnosis of craniosynostosis. In most craniofacial centers, at least one three-dimensional (3D) computed tomographic scan is obtained in every case of suspected craniosynostosis. However, with regard to the risk of radiation exposure particularly in young infants, CT scanning and even plain radiography should be indicated extremely carefully. Our current diagnostic protocol in the management of single-suture craniosynostosis is mainly based on careful clinical examination with regard to severity and degree of the abnormality and on ophthalmoscopic surveillance. Imaging techniques consist of ultrasound examination in young infants while routine plain radiographs are usually postponed to the date of surgery or the end of the first year. CT and magnetic resonance imaging (MRI) are confined to special diagnostic problems rarely encountered in isolated craniosynostosis. The results of this approach were evaluated retrospectively in 137 infants who were referred to our outpatient clinic for evaluation and/or treatment of suspected single suture craniosynostosis or positional deformity during a 2-year period (2008-2009). In 133 (97.1%) of the 137 infants, the diagnosis of single-suture craniosynostosis (n = 110) or positional plagiocephaly (n = 27) was achieved through clinical analysis only. Two further cases were classified by ultrasound, while the remaining two cases needed additional digital radiographs. In no case was CT scanning retrospectively considered necessary for establishing the diagnosis. Yet in 17.6% of cases, a cranial CT scan had already been performed elsewhere (n = 16) or had been definitely scheduled (n = 8). CT scanning is rarely necessary for evaluation of single-suture craniosynostosis. Taking into account that there is a quantifiable risk of developing cancer in further lifetime, every single CT scan should be carefully indicated.
Weaver, J M; Lu, Mei; McCloskey, K L; Herndon, E S; Tanaka, W
To develop digital multimedia instruction on intraoral suturing. A DVD was developed to describe instruments, materials, and techniques. Two groups of dental students were asked to close an incision in a simulated model. One used written materials only and another used additional DVD. The performance was evaluated using 10 grading criteria. Students who used the DVD performed better than students who did not. This DVD could be used widely in teaching dental students.
Bondre, Ioana L; Holihan, Julie L; Askenasy, Erik P; Greenberg, Jacob A; Keith, Jerrod N; Martindale, Robert G; Roth, J Scott; Liang, Mike K
Data are lacking to support the choice between suture, synthetic mesh, or biologic matrix in contaminated ventral hernia repair (VHR). We hypothesize that in contaminated VHR, suture repair is associated with the lowest rate of surgical site infection (SSI). A multicenter database of all open VHR performed at from 2010-2011 was reviewed. All patients with follow-up of 1 mo and longer were included. The primary outcome was SSI as defined by the Centers for Disease Control and Prevention. The secondary outcome was hernia recurrence (assessed clinically or radiographically). Multivariate analysis (stepwise regression for SSI and Cox proportional hazard model for recurrence) was performed. A total of 761 VHR were reviewed for a median (range) follow-up of 15 (1-50) mo: there were 291(38%) suture, 303 (40%) low-density and/or mid-density synthetic mesh, and 167(22%) biologic matrix repair. On univariate analysis, there were differences in the three groups including ethnicity, ASA, body mass index, institution, diabetes, primary versus incisional hernia, wound class, hernia size, prior VHR, fascial release, skin flaps, and acute repair. The unadjusted outcomes for SSI (15.1%; 17.8%; 21.0%; P = 0.280) and recurrence (17.8%; 13.5%; 21.5%; P = 0.074) were not statistically different between groups. On multivariate analysis, biologic matrix was associated with a nonsignificant reduction in both SSI and recurrences, whereas synthetic mesh associated with fewer recurrences compared to suture (hazard ratio = 0.60; P = 0.015) and nonsignificant increase in SSI. Interval estimates favored biologic matrix repair in contaminated VHR; however, these results were not statistically significant. In the absence of higher level evidence, surgeons should carefully balance risk, cost, and benefits in managing contaminated ventral hernia repair. Copyright © 2016 Elsevier Inc. All rights reserved.
Burrows, Anthony M; Rayan, Tarek; Van Gompel, Jamie J
Extradural approach to the cavernous sinus, the "Dolenc" approach recognizing its developing Dr. Vinko Dolenc, is a critically important skull base approach. However, resection of the lateral wall of the cavernous sinus, most commonly for cavernous sinus meningiomas, results commonly in a defect that often cannot be reconstructed in a water-tight fashion. This may result in troublesome pseudomeningocele postoperatively. To describe a technique designed to mitigate the development of pseudomeningocele. We found the Dolenc approach critical for resection of cavernous lesions. However, a number of pseudomeningoceles were managed with prolonged external pressure wrapping in the early cohort. Therefore, we incorporated subgaleal to muscular sutures, which were designed to close this potential space and retrospectively analyzed our results. Twenty-one patients treated with a Dolenc approach and resection of the lateral wall of the cavernous sinus over a 2-year period were included. Prior to incorporation of this technique, 12 patients were treated and 3 (25%) experienced postoperative pseudomeningoceles requiring multiple clinic visits and frequent dressing. After incorporation of subgaleal retention sutures, no patient (0%) experienced this complication. Although basic, subgaleal to temporalis muscle retention sutures likely aid in eliminating this potential dead space, thereby preventing patient distress postoperatively. This technique is simple and further emphasizes the importance of dead space elimination in complex closures. Copyright © 2017 by the Congress of Neurological Surgeons
Stahl, Kenneth D; Moon, Harry K; Gorensek, Margaret J; McCarthy, Patrick; Cosgrove, Delos M
Sternal wound infection complicating open-heart surgery is a potentially devastating complication that has been associated with a number of risk factors. We recently consulted on three consecutive patients with this complication who had heavy nonabsorbable parasternal sutures placed in muscle tissue adjacent to the sternum. The aim of this report is to document our findings and caution that this technique to control bleeding from the parasternal intercostal muscles my increase risk of infection. The pathology, surgical findings, and microbiology of these three cases are analyzed for similarity and possible cause of infection. By surgical observation and culture reports, each infection appeared to have originated at the site of nonabsorbable suture in devascularized parasternal muscle tissue. Sinus tracts could be probed to a similar site in each patient. Placement of sutures in the parasternal muscles where the sternal wires wrap around the bone leads to compression and necrosis of muscle tissue. We caution that this technique to control bleeding may cause a nidus of infection and increase the risk of deep sternal wound infection.
Indeyeva, Y A; Lee, T S; Gordin, E; Chan, D; Ducic, Y
Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Yoshimura, Ichiro; Hagio, Tomonobu; Noda, Masahiro; Kanazawa, Kazuki; Minokawa, So; Yamamoto, Takuaki
In this study, the distance between the insertion point of the suture anchors and posterior surface of the fibula during arthroscopic lateral ankle ligament repair was investigated on computed tomography (CT) images. The hypothesis of this study was that there is an optimal insertional direction of the suture anchor to avoid anchor-related complications. One hundred eleven ankles of 98 patients who had undergone three-dimensional CT scans for foot or ankle disorders without deformity of the fibula were assessed (59 males, 52 females; median age 25.5 years; age range 12-78 years). The shortest distance from the insertion point of the suture anchor to the deepest point of the fossa/top of the convex aspect of the fibula was measured on the axial plane, tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. The distance from the insertion point of the suture anchor to the posterior surface of the fibula was also measured in a direction parallel to the sagittal plane of the lateral surface of the talus on the axial plane, tilting from the longitudinal axis of the fibula at 90°, 75°, 60°, and 45°. The posterior fossa was observed in all cases on the 90° and 75° images. The distance from the insertion point to the posterior surface of the fibula in the parallel direction was 15.0 ± 3.4 mm at 90°, 17.5 ± 3.2 mm at 75°, 21.7 ± 3.3 mm at 60°, and 25.7 ± 3.6 mm at 45°. The posterior points in the parallel direction were located on the posterior fossa in 36.0% of cases at 90°, in 12.6% at 75°, and in 0.0% at 60° and 45°. The suture anchor should be directed from anterior to posterior at an angle of <45° to the longitudinal axis of the fibula, parallel to the lateral surface of the talus, to avoid passing through the fibula. Cohort study, Level III.
Lund, K.; Aleinikoff, J.N.; Yacob, E.Y.; Unruh, D.M.; Fanning, C.M.
During dextral oblique translation along Laurentia in western Idaho, the Blue Mountains superterrane underwent clockwise rotation and impinged into the Syringa embayment at the northern end of the Salmon River suture. Along the suture, the superterrane is juxtaposed directly against western Laurentia, making this central Cordilleran accretionary-margin segment unusually attenuated. In the embayment, limited orthogonal contraction produced a crustal wedge of oceanic rocks that delaminated Laurentian crust. The wedge is exposed through Laurentian crust in the Coolwater culmination as documented by mapping and by sensitive high-resolution ion microprobe U-Pb, Sri, and ??Nd data for gneisses that lie inboard of the suture. The predominant country rock is Mesoproterozoic paragneiss overlying Laurentian basement. An overlying Neoproterozoic (or younger) paragneiss belt in the Syringa embayment establishes the form of the Cordilleran miogeocline and that the embayment is a relict of Rodinia rifting. An underlying Cretaceous paragneiss was derived from arc terranes and suture-zone orogenic welt but also from Laurentia. The Cretaceous paragneiss and an 86-Ma orthogneiss that intruded it formed the wedge of oceanic rocks that were inserted into the Laurentian margin between 98 and 73 Ma, splitting supracrustal Laurentian rocks from their basement. Crustal thickening, melting and intrusion within the wedge, and folding to form the Coolwater culmination continued until 61 Ma. The embayment formed a restraining bend at the end of the dextral transpressional suture. Clockwise rotation of the impinging superterrane and overthrusting of Laurentia that produced the crustal wedge in the Coolwater culmination are predicted by oblique collision into the Syringa embayment. Copyright 2008 by the American Geophysical Union.
Chandrasekar, Shruthi; Jeyakumar, S; Ganapathy, Tharun
Inguinal hernia is one of the most common surgical problem presenting to the surgical OPD. Surgery is the mainstay of treatment for inguinal hernia today. Surgery for inguinal hernia has undergone a great evolution over a period of several centuries. Lichenstein's tension free hernioplasty is the one of the first surgeries taught to a surgical resident. The main aim of surgeries in this era is to give the best possible results with the least possible pain, scar and time. This has given rise to so many modifications to the classical Lichenstein's procedure and also to laparoscopic hernioplasty. Pain after inguinal hernia surgery is found to be debilitating and altering the quality of life in several patients, which has been attributed to the traumatic fixation of the mesh with sutures. This has paved way to the development of various atraumatic methods of fixation, tissue glue is one such development. Hence this study, to compare traumatic and atraumatic methods of mesh fixation in inguinal hernia repair. The aim of this study was to compare suture fixation versus tissue glue fixation of the mesh in inguinal hernia repair. Primary objective was to compare the immediate and chronic post-operative pain. Secondary objective was to compare the time taken for the procedure by the two methods in use and also to compare the presence of any complications. and methodology: This study was done in the General Surgery department of XXX hospital, medical college and research centre, kattangulathur after Ethics committee clearance. It is a single blinded study. The study was done on 51 patients consenting for the study and meeting the inclusion criterias from the period of March 2016 to August 2017 out of which 26 were selected for glue mesh fixation and 25 for suture mesh fixation according to simple randomization. The suture group patients underwent classical Lichenstein's tension free hernioplasty and the glue group underwent Lichenstein's hernioplasty with glue where dots of
Kevin T. Smith
Zone lines are narrow, usually dark markings formed in decaying wood. Zone lines are found most frequently in advanced white rot of hardwoods, although they occasionally are associated both with brown rot and with softwoods.
Renko, Marjo; Paalanne, Niko; Tapiainen, Terhi; Hinkkainen, Matti; Pokka, Tytti; Kinnula, Sohvi; Sinikumpu, Juha-Jaakko; Uhari, Matti; Serlo, Willy
Surgical site infections (SSIs) are a pervasive problem in surgery. Sutures coated or impregnated with triclosan might reduce the occurrence of SSIs, but evidence of their efficacy is limited, especially in children. We designed a randomised, double-blind, controlled trial in patients who underwent elective or daytime emergency surgery at Oulu University Hospital (Oulu, Finland). We included children younger than 18 years staying in the paediatric surgery and orthopaedics ward for any elective or emergency surgery during the daytime and with anticipated use of absorbing sutures. Children were randomly allocated (1:1) to receive either triclosan-containing sutures or ordinary absorbing sutures. The primary outcome was the occurrence of superficial or deep surgical site infections according to the Centers for Disease Control and Prevention criteria within 30 days after surgery. The primary analysis was with modified intention to treat. This trial is registered at ClinicalTrials.gov, number NCT01220700. Between September, 2010, and December, 2014, 1633 children were recruited. In the modified intention-to-treat group, SSIs occurred in 20 (3%) of 778 patients allocated to receive triclosan-containing sutures and in 42 (5%) of 779 patients allocated to receive control sutures (risk ratio 0·48, 95% CI 0·28-0·80). To prevent one SSI, triclosan-containing sutures had to be used in 36 children (95% CI 21-111). One patient died from suspected mitochondrial disease; no other expected or unexpected adverse events were reported in either of the groups. Use of triclosan-containing sutures effectively reduced the occurrence of all SSIs compared with normal sutures. The results accord with the results of meta-analyses of previous studies in adults. Use of triclosan-containing sutures is a simple way to reduce SSIs in children. The Alma and K A Snellman Foundation. Copyright © 2017 Elsevier Ltd. All rights reserved.
Hennecke, Kathleen; Redeker, Joern; Kuhbier, Joern W.; Strauss, Sarah; Allmeling, Christina; Kasper, Cornelia; Reimers, Kerstin; Vogt, Peter M.
Repair success for injuries to the flexor tendon in the hand is often limited by the in vivo behaviour of the suture used for repair. Common problems associated with the choice of suture material include increased risk of infection, foreign body reactions, and inappropriate mechanical responses, particularly decreases in mechanical properties over time. Improved suture materials are therefore needed. As high-performance materials with excellent tensile strength, spider silk fibres are an extremely promising candidate for use in surgical sutures. However, the mechanical behaviour of sutures comprised of individual silk fibres braided together has not been thoroughly investigated. In the present study, we characterise the maximum tensile strength, stress, strain, elastic modulus, and fatigue response of silk sutures produced using different braiding methods to investigate the influence of braiding on the tensile properties of the sutures. The mechanical properties of conventional surgical sutures are also characterised to assess whether silk offers any advantages over conventional suture materials. The results demonstrate that braiding single spider silk fibres together produces strong sutures with excellent fatigue behaviour; the braided silk sutures exhibited tensile strengths comparable to those of conventional sutures and no loss of strength over 1000 fatigue cycles. In addition, the braiding technique had a significant influence on the tensile properties of the braided silk sutures. These results suggest that braided spider silk could be suitable for use as sutures in flexor tendon repair, providing similar tensile behaviour and improved fatigue properties compared with conventional suture materials. PMID:23613793
An option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: A single-layer suturing technique for the stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures.
Tokuhara, Takaya; Nakata, Eiji; Tenjo, Toshiyuki; Kawai, Isao; Kondo, Keisaku; Ueda, Hirofumi; Tomioka, Atsushi
We report an option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. We detail a single-layer suturing technique for the endoscopic linear stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures. From June 2013 to February 2017, we performed TLDG with delta-shaped gastroduodenostomy in 20 patients with gastric cancer. The linear stapler was closed and fired to attach the posterior walls of the remnant stomach and the duodenum together. After creating a good view of the greater curvature side of the entry hole for the stapler by retracting the knotted suture on the lesser curvature side toward the ventral side, we performed single-layer entire-thickness continuous suturing of this hole using a 15-cm-long barbed suture running from the greater curvature side to the lesser curvature side. We placed the second and third stitches between the seromuscular layer of the remnant stomach and the entire-thickness layer of the duodenum while suturing the duodenal mucosa as minutely as possible. In addition, we routinely added one or two entire-thickness knotted sutures at the site near the greater curvature side. We placed similar additional knotted sutures at the site with a broad pitch. TLDG with this reconstruction technique was successfully performed in all patients with no occurrences of anastomotic leakage or intraabdominal abscess around the anastomosis. It is suggested that this method can be one option for delta-shaped gastroduodenostomy in TLDG due to its cost-effectiveness and feasibility.
An option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: A single-layer suturing technique for the stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures
Tokuhara, Takaya; Nakata, Eiji; Tenjo, Toshiyuki; Kawai, Isao; Kondo, Keisaku; Ueda, Hirofumi; Tomioka, Atsushi
We report an option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. We detail a single-layer suturing technique for the endoscopic linear stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures. From June 2013 to February 2017, we performed TLDG with delta-shaped gastroduodenostomy in 20 patients with gastric cancer. The linear stapler was closed and fired to attach the posterior walls of the remnant stomach and the duodenum together. After creating a good view of the greater curvature side of the entry hole for the stapler by retracting the knotted suture on the lesser curvature side toward the ventral side, we performed single-layer entire-thickness continuous suturing of this hole using a 15-cm-long barbed suture running from the greater curvature side to the lesser curvature side. We placed the second and third stitches between the seromuscular layer of the remnant stomach and the entire-thickness layer of the duodenum while suturing the duodenal mucosa as minutely as possible. In addition, we routinely added one or two entire-thickness knotted sutures at the site near the greater curvature side. We placed similar additional knotted sutures at the site with a broad pitch. TLDG with this reconstruction technique was successfully performed in all patients with no occurrences of anastomotic leakage or intraabdominal abscess around the anastomosis. It is suggested that this method can be one option for delta-shaped gastroduodenostomy in TLDG due to its cost-effectiveness and feasibility. PMID:29375711
James, Evan W; LaPrade, Christopher M; Feagin, John A; LaPrade, Robert F
Complete radial meniscus tears have been reported to result in deleterious effects in the knee joint if left unrepaired. An emphasis on meniscal preservation is important in order to restore native meniscal function. In this case report, a complete radial tear of the medial meniscus midbody was repaired using a novel crisscross suture transtibial technique. This technique secured the anterior and posterior meniscal horns, which were released from their extruded and scarred position along the capsule, using crisscrossing sutures passed through two transtibial tunnels and secured over a bone bridge on the anterolateral tibia. In addition, the repair was supplemented with the injection of platelet-rich plasma and bone marrow aspirate concentrate to promote the healing of the meniscal tissue. Complete healing on second-look arthroscopy is presented, including in the previously unreported white-white meniscal zone.
Chen, Jianjun; Zhong, Ming
Regardless of laparoscopic or open colorectal surgeries, intestinal anastomosis is usually an important operative procedure. Even if stapler is widely used in different intestinal surgery nowadays, hand sewn suture is an indispensable procedure in clinical practice, meanwhile after stapled anastomosis, additional hand sewn suture is usually performed to ensure the safety of anastomosis. The inner figure-of-eight suture is a single layer suture technique which has been widely used in skin, tendon, rectus and uterus for quick and secure approximation. We describe our innovative application of inner figure-of-eight suture technique for intestinal anastomosis and/or reinforcement after stapled anastomosis in laparoscopic colorectal surgery. Main steps of inner figure-of-eight suture for intestinal anastomosis on posterior wall are as follows: (1) At 4 mm from cut edge of bowel, needle enters vertically from one side and courses mucosa-serosa-opposite serosa-mucosa in parallel to the entry point. (2) The needle is brought back to first entry side of bowel at 45 degree to enter the mucosa 5 mm below the first entry point and out on opposite side mucosa horizontally. (3) Both lose ends of the suture are pulled to approximate bowel edges and knots are tied on mucosal surface, in which suture line presents figure-of-eight on mucosal surface and two parallel suture lines are seen on serosal surface. When inner figure-of-eight suture is performed on anterior wall, the procedure is similar, but needle passes from serosa-mucosa-opposite mucosa-serosa and repeated to complete the inner figure-8 suture and knots are tied on serosa. The final look is two parallel sutures at 0.5 mm in between and the figure-of-eight remains inside the lumen. We did not deliberately try to invert the bowel edges, and if anastomosis is not satisfactory at final examination, simple interrupted seromuscular suture can be carried out. From 2015 till now, we have successfully completed inner figure
Kujala, Sauli; Pajala, Ari; Kallioinen, Matti; Pramila, Antti; Tuukkanen, Juha; Ryhänen, Jorma
Nitinol (NiTi) is a promising new tendon suture material with good strength, easy handling and good super-elastic properties. NiTi sutures were implanted for biocompatibility testing into the right medial gastrocnemius tendon in 15 rabbits for 2, 6 and 12 weeks. Additional sutures were implanted in subcutaneous tissue for strength measurements in order to determine the effect of implantation on strength properties of NiTi suture material. Braided polyester sutures (Ethibond) of approximately the same diameter were used as control. Encapsulating membrane formation around the sutures was minimal in the case of both materials. The breaking load of NiTi was significantly greater compared to braided polyester. Implantation did not affect the strength properties of either material.
Muftuoglu, M A Tolga; Ozkan, Erkan; Saglam, Abdullah
Several suture materials are used for pancreatojejunal anastomosis. In this study, we tested the durability of these suture materials in human pancreatic juice and bile. Plain and chromic catgut, polyglactin 910, polyglycolic acid, polydioxanone, polypropylene, and silk sutures were incubated in pancreatic juice and bile that was collected from patients. Fifteen samples of each type of suture material were placed in human juices for 1, 3, and 7 days. Tensile strengths were measured with a tensionmeter. Plain and chromic catgut disintegrated in pancreatic juice and pancreatic juice plus bile mixture. Polyglycolic acid and polyglactin 910 suture materials were vulnerable to pancreatic juice within 7 days. Polydioxanone retained most of its initial strength in pancreatic juice and bile. Polypropylene and silk retained 84% and 92% of their initial strength, respectively. We found that polidioxanone was the strongest suture material in pancreatic juice.
Becker, G.; Knapmeyer-Endrun, B.
We derive autocorrelations from ambient seismic noise to image the reflectivity of the subsurface and to extract the Moho depth beneath the stations for two different data sets in Central Europe. The autocorrelations are calculated by smoothing the spectrum of the data in order to suppress high amplitude, narrow-band signals of industrial origin, applying a phase autocorrelation algorithm and time-frequency domain phase-weighted stacking. The stacked autocorrelation results are filtered and analysed predominantly in the frequency range of 1-2 Hz. Moho depth is automatically picked inside uncertainty windows obtained from prior information. The processing scheme we developed is applied to data from permanent seismic stations located in different geological provinces across Europe, with varying Moho depths between 25 and 50 km, and to the mainly short period temporary PASSEQ stations along seismic profile POLONAISE P4. The autocorrelation results are spatially and temporarily stable, but show a clear correlation with the existence of cultural noise. On average, a minimum of six months of data is needed to obtain stable results. The obtained Moho depth results are in good agreement with the subsurface model provided by seismic profiling, receiver function estimates and the European Moho depth map. In addition to extracting the Moho depth, it is possible to identify an intracrustal layer along the profile, again closely matching the seismic model. For more than half of the broad-band stations, another change in reflectivity within the mantle is observed and can be correlated with the lithosphere-asthenosphere boundary to the west and a mid-lithospheric discontinuity beneath the East European Craton. With the application of the developed autocorrelation processing scheme to different stations with varying crustal thicknesses, it is shown that Moho depth can be extracted independent of subsurface structure, when station coverage is low, when no strong seismic sources are present, and when only limited amounts of data are available.
Tucker, R.D.; Roig, J.-Y.; Delor, C.; Amlin, Y.; Goncalves, P.; Rabarimanana, M.H.; Ralison, A.V.; Belcher, R.W.
The Precambrian shield of Madagascar is reevaluated with recently compiled geological data and new U-Pb sensitive high-resolution ion microprobe (SHRIMP) geochronology. Two Archean domains are recognized: the eastern Antongil-Masora domain and the central Antananarivo domain, the latter with distinctive belts of metamafic gneiss and schist (Tsaratanana Complex). In the eastern domain, the period of early crust formation is extended to the Paleo-Mesoarchean (3.32-3.15 Ga) and a supracrustal sequence (Fenerivo Group), deposited at 3.18 Ga and metamorphosed at 2.55 Ga, is identified. In the central domain, a Neoarchean period of high-grade metamorphism and anatexis that affected both felsic (Betsiboka Suite) and mafic gneisses (Tsaratanana Complex) is documented. We propose, therefore, that the Antananarivo domain was amalgamated within the Greater Dharwar Craton (India + Madagascar) by a Neoarchean accretion event (2.55-2.48 Ga), involving emplacement of juvenile igneous rocks, high-grade metamorphism, and the juxtaposition of disparate belts of mafic gneiss and schist (metagreenstones). The concept of the "Betsimisaraka suture" is dispelled and the zone is redefined as a domain of Neoproterozoic metasedimentary (Manampotsy Group) and metaigneous rocks (Itsindro-Imorona Suite) formed during a period of continental extension and intrusive igneous activity between 840 and 760 Ma. Younger orogenic convergence (560-520 Ma) resulted in east-directed overthrusting throughout south Madagascar and steepening with local inversion of the domain in central Madagascar. Along part of its length, the Manampotsy Group covers the boundary between the eastern and central Archean domains and is overprinted by the Angavo-Ifanadiana high-strain zone that served as a zone of crustal weakness throughout Cretaceous to Recent times.
Mackool, Richard J; Monsanto, Vivian R
We describe a surgical technique to manage persistent corneal striae after laser in situ keratomileusis (LASIK). The sequential lift and suture technique reduces the time required for LASIK, eliminates the need to fixate the flap with forceps during suturing, and increases the accuracy of suture placement. The results in 10 eyes (9 patients) showed complete resolution of striae with improvement in subjective symptoms (glare and blurred vision) and best corrected visual acuity.
Chughtai, T; Chen, L Q; Salasidis, G; Nguyen, D; Tchervenkov, C; Morin, J F
Coronary artery bypass grafting (CABG) is one of the most common procedures performed today, and wound complications are a major source of morbidity and cost. To determine whether there is any difference in wound outcome (including cost in a Canadian context) between a subcuticular suture technique and skin stapling technique for closure of sternal and leg incisions in CABG patients. One hundred and sixty-two patients undergoing CABG were prospectively, randomly placed to have their sternal and leg incisions closed with either a subcuticular suture technique or with a skin clip. Data were obtained through chart review, in-hospital assessments and follow-up visits. Nonblinded assessments were made regarding wound leakage, inflammation, infection, necrosis, swelling, dehiscence and cosmesis. Each of the parameters was graded on a scale from 1 to 4. The cost was evaluated in Canadian dollars. There were trends toward increased rates of in-hospital sternal (P=0.09) and leg (P=0.17) incision inflammation when the wounds were closed with skin clips. There was a significantly greater (P=0.05) rate of sternal wound infection with clips, as well as a tendency (P=0.15) toward a greater rate of mediastinitis at follow-up assessment. Cosmetic outcome was similar for both groups. The cost incurred was significantly greater when skin clips were used for closure. There was a greater than threefold difference, which translates to a greater than $10,000 difference over one year. Closure with a subcuticular technique achieves better outcomes than the use of skin clips. When factoring in the increased cost incurred by using clips, as well as other intangible factors such as surgical skill acquisition, subcuticular suture closure appears to be a favourable method of wound closure in CABG patients compared with the use of skin stapling techniques.
Du, Dongxing; Jiang, Song; Wang, Ze; Hu, Yingying; He, Zhaoming
Mitral valve (MV) edge-to-edge repair (ETER) is a surgical procedure for the correction of mitral valve regurgitation by suturing the free edge of the leaflets. The leaflets are often sutured at three different positions: central, lateral and commissural portions. To study the effects of position of suture on left ventricular (LV) fluid mechanics under mitral valve ETER, a parametric model of MV-LV system during diastole was developed. The distribution and development of vortex and atrio-ventricular pressure under different suture position were investigated. Results show that the MV sutured at central and lateral in ETER creates two vortex rings around two jets, compared with single vortex ring around one jet of the MV sutured at commissure. Smaller total orifices lead to a higher pressure difference across the atrio-ventricular leaflets in diastole. The central suture generates smaller wall shear stresses than the lateral suture, while the commissural suture generated the minimum wall shear stresses in ETER.
Kim, Tae Won B; Kamath, Atul F; Israelite, Craig L
Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA. Copyright © 2011 Elsevier Inc. All rights reserved.
Khonsari, R H; Di Rocco, F; Arnaud, E; Sanchez, S; Tafforeau, P
The developmental genetics and the biomechanics of sutures are well-studied topics, while their microanatomy is still imperfectly known. Here, we aim to investigate the structure of skull vault sutures using a high-resolution imaging device. We used synchrotron X-ray microtomography in order to obtain high-resolution images of skull vault sutures from an extant mammal (the mouse Mus musculus) and from an extinct fish (the placoderm Compagopiscis croucheri). We used segmentation and 3D reconstruction softwares in order to reveal the microanatomy of sutures in these species. The high-resolution images allowed us to study the distribution of osteocytes, the organisation of vascular canals, the shapes of the suture borders, the insertion of Sharpey's fibres, the bone growth lines and the structure of the soft tissues surrounding the sutures. Synchrotron imaging provides new perspectives for the study of the normal microanatomy of sutures. The submicronic resolution of the synchrotron scans gives access to the 3D organisation of structures that were previously only known in 2D, even in normal sutures. The description of anatomical entities such as vascular canals and Sharpey's fibres in abnormally fused sutures would be of interest in the understanding of craniosynostoses.
Emam, T A; Hanna, G; Cuschieri, A
Laparoscopic suturing is technically a demanding skill in laparoscopic surgery. Ergonomic experimental studies provide objective information on the important factors and variables that govern optimal endoscopic suturing. Our objective was to determine the optimum physical alignment, visual display, and direction of intracorporeal laparoscopic bowel suturing using infrared motion analysis and telemetric electromyography (EMG) systems. Ten surgeons participated in the study; each sutured 50-mm porcine small bowel enterotomies toward and away from the surgeon in the vertical and horizontal bowel plane with either isoplanar (image display corresponds with actual lie of the bowel) or nonisoplanar (bowel displayed horizontally but mounted vertically in the trainer and vice versa) display. The end points were the placement error score, execution time, leakage pressure, motion analysis, and telemetric EMG parameters of the surgeon's dominant upper limb. Suturing was demonstrably easier in the vertical than in the horizontal plane, resulting in a better task quality (placement error score, p < 0.0001; leakage pressure, p < 0.005) and shorter execution time (p < 0.05). Nonisoplanar display of the surgical anatomy degrades performance in terms of both task efficiency and task quality. On motion analysis, a wider angle of excursion and lower angular velocity were observed during the vertical suturing with isoplaner display. Compared to horizontal suturing, supination at the wrist was significantly greater during vertical than horizontal suturing (p < 0.05). Within each category (vertical vs horizontal suturing), the direction of suturing (toward/away from the surgeon) did not influence the extent of pronation/ supination at the wrist. In line with the degraded performance, significantly more muscle work was expended during horizontal suturing. This affected the forearm flexors (p < 0.05), arm flexors and extensors (p < 0.005 and p < 0.05, respectively), and deltoid muscles (p
Gao, Xu; Lu, Xin; Ren, Shancheng; Xu, Chuanliang; Sun, Yinghao
The aim of this paper is to report a simple solution for inadvertently sutured drainage tube after urological surgery and discuss the different managements according to different types of this embarrassing complication. From September 2001 to January 2007, five inadvertently sutured drainage tubes were treated with ureteroscopic holmium laser cutting for the suture. All drainage tubes were removed after the operation without other complications. Holmium laser cutting via ureteroscope is a simple solution for the embarrassing problem of inadvertently sutured drainage tube. It can save the patient from undergoing another open surgery.
Griesser, H J; Chatelier, R C; Martin, C; Vasic, Z R; Gengenbach, T R; Jessup, G
Fine elastomeric sutures intended for cardiovascular surgery can exhibit "stick-slip" behavior as they are pulled through tissue; the resulting oscillatory force can damage delicate tissue or cause sutures to snap. To eliminate this undesirable effect, sutures were surface-modified using a radiofrequency glow discharge in a vapor of either hexamethyldisiloxane or hexamethyldisilazane, to produce a thin polymeric coating on the suture. The same coatings were also deposited onto aluminized tape to facilitate their characterization by measurement of air/water contact angles and by X-ray photoelectron spectroscopy. Coatings from both monomers were found to be very hydrophobic. The hexamethyldisiloxane glow discharge coatings underwent negligible oxidation when stored in air, and thus remained stable over a shelf-life period akin to what may be required of sutures. The hexamethyldisilazane glow discharge coatings, in contrast, incorporated substantial amounts of oxygen over a 3-month period. The coatings did not measurably alter the tensile properties of the sutures. The frictional properties of coated sutures were assessed by measuring the dynamic friction between the suture and ovine myocardium. Both coatings were effective in removing the inherent stick-slip behavior of polybutester sutures in this model. The coatings remained intact after several passes and proved to be robust and efficacious under various strain regimes. Copyright 2000 John Wiley & Sons, Inc.
Ranganath, V.; Nichani, Ashish Sham
Purpose The purpose of this study was to evaluate the tensile strength of surgical synthetic absorbable sutures over a period of 14 days under simulated oral conditions. Methods Three suture materials (polyglycolic acid [PGA], polyglactin [PG] 910, and poly (glycolide-co-є-caprolactone) [PGC]) were used in 4-0 and 5-0 gauges. 210 suture samples (35 of each material and gauge) were used. All of the samples were tested preimmersion and 1 hour and 1, 3, 7, 10, and 14 days postimmersion. The tensile strength of each suture material and gauge was assessed. The point of breakage and the resorption pattern of the sutures were also assessed. Results During the first 24 hours of immersion, all 4-0 and 5-0 samples of PGA, PG 910, and PGC maintained their initial tensile strength. At baseline (preimmersion), there was a statistically significant (P<0.001) difference in the tensile strengths between the 4-0 and 5-0 gauge of PGA, PG 910, and PGC. PGA 4-0 showed the highest tensile strength until day 10. At 7 days, all the 4-0 sutures of the three materials had maintained their tensile strength with PGA 4-0 having significantly greater (P=0.003) tensile strength compared to PG. Conclusions 4-0 sutures are stronger and have greater tensile strength than 5-0 sutures. The PGA 4-0 suture showed the highest tensile strength at the end of day 10. PMID:23837127
Karaşahin, Emre Kazım; Esin, Sertaç; Alanbay, İbrahim; Ercan, Mutlu Cihangir; Mutlu, Erol; Başer, İskender; Basal, Şeref
Burch colposuspension remains one of the successful operations performed for stress incontinence. Accidental suturing of the bladder wall during the procedure or subsequent erosion may lead to lower urinary tract symptoms. Diagnosis and management of these sutures indicate precise evaluation for which a 70 degree cystoscope is used. In selected cases, Holmium-YAG laser may enable us to manage long-standing, encrustated neglected sutures. Here we would like to report successful removal of intravesical sutures using the Holmium-YAG laser. PMID:24591960
Kirsch, A J; Chang, D T; Kayton, M L; Libutti, S K; Connor, J P; Hensle, T W
Tissue welding using laser-activated protein solders may soon become an alternative to sutured tissue approximation. In most cases, approximating sutures are used both to align tissue edges and provide added tensile strength. Collateral thermal injury, however, may cause disruption of tissue alignment and weaken the tensile strength of sutures. The objective of this study was to evaluate the effect of laser welding on the tensile strength of suture materials used in urologic surgery. Eleven types of sutures were exposed to diode laser energy (power density = 15.9 W/cm2) for 10, 30, and 60 seconds. Each suture was compared with and without the addition of dye-enhanced albumin-based solder. After exposure, each suture material was strained (2"/min) until ultimate breakage on a tensometer and compared to untreated sutures using ANOVA. The strength of undyed sutures were not significantly affected; however, violet and green-dyed sutures were in general weakened by laser exposure in the presence of dye-enhanced glue. Laser activation of the smallest caliber, dyed sutures (7-0) in the presence of glue caused the most significant loss of tensile strength of all sutures tested. These results indicate that the thermal effects of laser welding using our technique decrease the tensile strength of dyed sutures. A thermally resistant suture material (undyed or clear) may prevent disruption of wounds closed by laser welding techniques.
Khan, Muhammad Adil Abbas; Jose, Rajive M; Ali, Syed Nadir; Yap, Lok Huei
Correction of partial ear deformities can be a challenging task for the plastic surgeon. There are no standard techniques for correcting many of these deformities, and several different techniques are described in literature. Stahl ear is one such anomaly, characterized by an accessory third crus in the ear cartilage, giving rise to an irregular helical rim. The conventional techniques of correcting this deformity include either excision of the cartilage, repositioning of the cartilage, or scoring techniques. We recently encountered a case of Stahl ear deformity and undertook correction using internal sutures with very good results. The technical details of the surgery are described along with a review of literature on correcting similar anomalies.
Joshi, Deepak; Jain, Jitesh Kumar; Chaudhary, Deepak; Singh, Utkarsh; Jain, Vineet; Lal, Ajay
To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured. Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036). We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle.
Joshi, Deepak; Jain, Jitesh Kumar; Chaudhary, Deepak; Singh, Utkarsh; Jain, Vineet; Lal, Ajay
AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured. RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036). CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle. PMID:27795949
Costa-Almeida, Raquel; Domingues, Rui M A; Fallahi, Afsoon; Avci, Huseyin; Yazdi, Iman K; Akbari, Mohsen; Reis, Rui L; Tamayol, Ali; Gomes, Manuela E; Khademhosseini, Ali
Tendons have limited regenerative capacity due to their low cellularity and hypovascular nature, which results in poor clinical outcomes of presently used therapies. As tendon injuries are often observed in active adults, it poses an increasing socio-economic burden on healthcare systems. Currently, suture threads are used during surgical repair to anchor the tissue graft or to connect injured ends. Here, we created composite suture threads coated with a layer of cell-laden hydrogel that can be used for bridging the injured tissue aiming at tendon regeneration. In addition, the fibres can be used to engineer 3-dimensional constructs through textile processes mimicking the architecture and mechanical properties of soft tissues, including tendons and ligaments. Encapsulated human tendon-derived cells migrated within the hydrogel and aligned at the surface of the core thread. An up-regulation of tendon-related genes (scleraxis and tenascin C) and genes involved in matrix remodelling (matrix metalloproteinases 1, matrix metalloproteinases 2) was observed. Cells were able to produce a collagen-rich matrix, remodelling their micro-environment, which is structurally comparable to native tendon tissue. Copyright © 2017 John Wiley & Sons, Ltd.
Cotton, François; Rozzi, Fernando Ramirez; Vallee, Bernard; Pachai, Chahin; Hermier, Marc; Guihard-Costa, Anne-Marie; Froment, Jean-Claude
The main goal of the study was to determine on MRI the cranial sutures, the craniometric points and craniometric measurements, and to correlate these results with classical anthropometric measurements. For this purpose, we reviewed 150 cerebral MRI examinations considered as normal (Caucasian population aged 20-49 years). For each examination we individualized 11 craniometric landmarks (Glabella, Bregma, Lambda, Opisthocranion, Opisthion, Basion, Inion, Porion, Infra-orbital, Eurion) and three measurements. Measurements were also calculated independently on 498 dry crania (Microscribe 3-DX digitizer). To validate the MRI procedure, we measured four dry crania by MRI and with compass or digital caliper gauges. Cranial sutures always appeared without signal (black), whatever the MRI sequence used, and they are better visualized with a 5 mm slice thickness (compact bone overlapping). Slice dynamic analysis and multiplanar reformatting allowed the detection of all craniometric points, some of these being more difficult to detect than others (Porion, Infra-orbital). The measurements determined by these points were as follows: Vertex-Basion height=135.66+/-6.56 mm; Eurion-Eurion width=141.17+/-5.19 mm; Glabella-Opisthocranion length=181.94+/-6.40 mm. On the midline T1-weighted sagittal image, all median craniometric landmarks can be individualized and the Glabella-Opisthocranion length, Vertex-Basion height and parenchyma indices can be calculated. Craniometric points and measurements between these points can be estimated with a standard cerebral MRI examination, with results that are similar to anthropometric data.
Lehman, Ronald A; Murphy, Kevin P; Machen, M Shaun; Kuklo, Timothy R
This study describes a new arthroscopic method using a whip-stitch technique for treating a displaced type III tibial eminence fracture. A 12-year-old girl who sustained a displaced type III tibial eminence fracture was treated with arthroscopic fixation using the Arthrosew disposable suture device (Surgical Dynamics, Norwalk, CT) to place a whip stitch into the anterior cruciate ligament (ACL). The Arthrex ACL guide (Arthrex, Naples, FL) was used to reduce the avulsed tibial spine fragment. Sutures were then passed through the tibial tunnel and secured over a bony bridge with the knee in 20 degrees of flexion. At 9 months, the patient has a full range of motion with normal Lachman and anterior drawer testing, and she has returned to competitive basketball. Radiographs show complete fracture healing. KT-1000 and isokinetic testing at 9-month follow-up show only minimal side-to-side differences. The Arthrosew device provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the ACL, thus obviating arthrotomy and hardware placement. This technique also restores the proper length and tension to the ACL, and provides a simplified, reproducible method of treatment for this injury.
Dedivitis, R A; Aires, F T; Pfuetzenreiter, E G; Castro, M A F; Guimarães, A V
The use of a stapler for pharyngeal closure during total laryngectomy was first described in 1971. It provides rapid watertight closure without surgical field contamination. The objective of our study was to compare the incidence of pharyngocutaneous fistula after total laryngectomy with manual and mechanical closures of the pharynx. This was a non-randomised, prospective clinical study conducted at two tertiary medical centres from 1996 to 2011 including consecutive patients with laryngeal tumours who underwent total laryngectomy. We compared the incidence of pharyngocutaneous fistula between two groups of patients: in 20 patients, 75 mm linear stapler closure was applied, whereas in 67 patients a manual suture was used. Clinical data were compared between groups. The groups were statistically similar in terms of gender, age, diabetes mellitus, smoking and alcohol consumption and tumour site. The group of patients who underwent stapler-assisted pharyngeal closure had a higher number of patients with previous tracheotomy (p < 0.001) and previous chemoradiation (p < 0.001). The incidence of pharyngocutaneous fistula was 30% in the mechanical closure group and 20.9% in the manual suture group (p = 0.42). In conclusion the use of the stapler does not increase the rate of fistulae.
The attempts to suture wounds with mechanical device are very old, and their history is lost in the night of times. But more recently--that means less than two century ago--already before the true initial beginning of the modern surgery, after the birth of anaesthesiology with the "ether day--16 october 1846" there have been many efforts to develop new methods to join the tissue of the gut avoiding the danger of peritoneal contamination. The primitive tools of these ancient stapler were founded on the principle to compress with mechanical devices the two sides of the tissue to join. Very early in the past century, well before the appearance of the antibiotics, in the heart of the old Europe were developed and perfectionated devices able to join the intestinal tissue with metallic stitches: the primitive staplers. But after the end of the second world war the development has become bursting, with the progress of the Sovietic Institute of experimental research on surgical tools of Moscow and then with the mighty initiatives of the industrial power in the USA. The more important progress in this field was founded on the standardization of tools designed to fix metallic stitches on the gut, but very recently there are new attempts to use the more old principle of compression-suture on new basis. The results of this development, essential for modern surgery, are the standardization of the surgical technique, the shortening of operative times, and an important support to the new mininvasive approach to digestive surgery.
Climenhaga, H W; Pearce, W G
The likelihood of forward "creep" of muscles recessed with the use of adjustable loops of suture in the correction of strabismus was investigated. Twelve orthotropic dogs underwent both regular and loop recessions of the lateral and medial rectus muscles; the data for two of the dogs were excluded because of loss of muscles. Three months later it was found that in the majority of cases the recessed muscles had minimally advanced from the position of surgical placement. Although the type of recession made little difference to the results, the mean forward creep was much greater for the medial rectus muscles (1.55 +/- 0.68 mm [p less than 0.01] and 2.00 +/- 2.44 mm [p = 0.09] for those undergoing regular and loop recessions respectively) than for the lateral rectus muscles (0.35 +/- 0.58 mm and 0.60 +/- 0.62 mm respectively). During the operations the amount of contraction of the medial rectus muscle had been noted to vary. It is likely that in some instances the tension on the suture loops was insufficient to hold them taut, and the muscles therefore adhered to the sclera at variable sites. Hence, adequate intrinsic muscle tone may be important for predictable clinical results of loop recession.
Kiliçoğlu, Onder; Türker, Mehmet; Yildız, Fatih; Akalan, Ekin; Temelli, Yener
Distal Achilles tendon avulsions are in the form of either bony and nonbony avulsion of Achilles tendon from its calcaneal insertion. Four patients with distal Achilles tendon avulsions or ruptures which were treated with tendon to bone repair using suture anchors are presented here. Operated leg was immobilized in above-knee cast for 4 weeks while the patient walked non-weight-bearing. Then, cast was changed to below knee, and full weight-bearing was allowed. Patients underwent gait analysis minimum at first postoperative year. Mean American Orthopedics Foot Ankle Society ankle/hindfoot score of patients at last visit was 88.75 (range 85-100), and Achilles tendon total rupture score was 77.75 (range 58-87). Mean passive dorsiflexion of injured ankles (14° ± 5°) was lower than uninjured ankles (23° ± 9°). All the kinematic parameters of gait analysis were comparable to the uninjured side. Maximum plantar flexion power of injured ankle was 1.40 W/kg, and this was significantly lower than the contralateral side value 2.38 W/kg; (P = 0.0143). There were no visually altered gait or problems in daily life. Suture anchor tenodesis technique of distal Achilles tendon avulsions was successful in achieving durable osteotendinous repairs.
Chen, Xiaojie; Hou, Dandan; Wang, Lu; Zhang, Qian; Zou, Jiahan; Sun, Gang
Sutures are a vital part for surgical operation, and suture-associated surgical site infections are an important issue of postoperative care. Antibacterial sutures have been proved to reduce challenging complications caused by bacterial infections. In recent decades, triclosan-free sutures have been on their way to commercialization. Alternative antibacterial substances are becoming relevant to processing surgical suture materials. Most of the antibacterial substances are loaded directly on sutures by dipping or coating methods. The aim of this study was to optimize novel antibacterial braided silk sutures based on levofloxacin hydrochloride and poly(ε-caprolactone) by two different processing sequences, to achieve suture materials with slow-release antibacterial efficacy and ideal physical and handling properties. Silk strands were processed into sutures on a circular braiding machine, and antibacterial treatment was introduced alternatively before or after braiding by two-dipping-two-rolling method (M1 group and M2 group). The antibacterial activity and durability against Staphylococcus aureus and Escherichia coli were tested. Drug release profiles were measured in phosphate buffer with different pH values, and release kinetics model was built to analyze the sustained drug release mechanism between the interface of biomaterials and the in vitro aqueous environment. Knot-pull tensile strength, thread-to-thread friction, and bending stiffness were determined to evaluate physical and handling properties of sutures. All coated sutures showed continuous antibacterial efficacy and slow drug release features for more than 5 days. Besides, treated sutures fulfilled U.S. Pharmacopoeia required knot-pull tensile strength. The thread-to-thread friction and bending stiffness for the M1 group changed slightly when compared with those of uncoated ones. However, physical and handling characteristics of the M2 group tend to approach those of monofilament ones. The novel suture
Obermeier, A; Schneider, J; Föhr, P; Wehner, S; Kühn, K-D; Stemberger, A; Schieker, M; Burgkart, R
Sutures colonized by bacteria represent a challenge in surgery due to their potential to cause surgical site infections. In order to reduce these type of infections antimicrobially coated surgical sutures are currently under development. In this study, we investigated the antimicrobial drug octenidine as a coating agent for surgical sutures. To achieve high antimicrobial efficacy and required biocompatibility for medical devices, we focused on optimizing octenidine coatings based on fatty acids. For this purpose, antimicrobial sutures were prepared with either octenidine-laurate or octenidine-palmitate at 11, 22, and 33 μg/cm drug concentration normalized per length of sutures. Octenidine containing sutures were compared to the commercial triclosan-coated suture Vicryl® Plus. The release of octenidine into aqueous solution was analyzed and long-term antimicrobial efficacy was assessed via agar diffusion tests using Staphylococcus aureus. For determining biocompatibility, cytotoxicity assays (WST-1) were performed using L-929 mouse fibroblasts. In a 7 days elution experiment, octenidine-palmitate coated sutures demonstrated much slower drug release (11 μg/cm: 7%; 22 μg/cm: 5%; 33 μg/cm: 33%) than octenidine-laurate sutures (11 μg/cm: 82%; 22 μg/cm: 88%; 33 μg/cm: 87%). Furthermore sutures at 11 μg/cm drug content were associated with acceptable cytotoxicity according to ISO 10993-5 standard and showed, similar to Vicryl® Plus, relevant efficacy to inhibit surrounding bacterial growth for up to 9 days. Octenidine coated sutures with a concentration of 11 μg/cm revealed high antimicrobial efficacy and biocompatibility. Due to their delayed release, palmitate carriers should be preferred. Such coatings are candidates for clinical testing in regard to their safety and efficacy.
Crisp, Catrina C; Herfel, Charles V; Pauls, Rachel N; Westermann, Lauren B; Kleeman, Steven D
This study aimed to characterize pertinent anatomy relative to the sacral suture placed at time of robotic sacrocolpopexy using postoperative computed tomography and magnetic resonance imaging. A vascular clip was placed at the base of the sacral suture at the time of robotic sacrocolpopexy. Six weeks postoperatively, subjects returned for a computed tomography scan and magnetic resonance imaging. Ten subjects completed the study. The middle sacral artery and vein coursed midline or to the left of midline in all the subjects. The left common iliac vein was an average of 26 mm from the sacral suture. To the right of the suture, the right common iliac artery was 18 mm away. Following the right common iliac artery to its bifurcation, the right internal iliac was on average 10 mm from the suture. The bifurcations of the inferior vena cava and the aorta were 33 mm and 54 mm further cephalad, respectively.The right ureter, on average, was 18 mm from the suture. The thickness of the anterior longitudinal ligament was 2 mm.The mean angle of descent of the sacrum was 70 degrees. Lastly, we found that 70% of the time, a vertebral body was directly below the suture; the disc was noted in 30%. We describe critical anatomy surrounding the sacral suture placed during robotic sacrocolpopexy. Proximity of both vascular and urologic structures within 10 to 18 mm, as well as anterior ligament thickness of only 2 mm highlights the importance of adequate exposure, careful dissection, and surgeon expertise.
Staton, Amy J.; Boyd, Christine B.
This capstone addresses an instructional gap in the Morehead State University Veterinary Technology Program and in other similar programs around the globe. Students do not retain the knowledge needed to proficiently complete suture patterns nor do students receive sufficient instructional time during the year to master each suture pattern that is…
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Absorbable poly(glycolide/l-lactide) surgical suture. 878.4493 Section 878.4493 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... device is FDA's “Class II Special Controls Guidance Document: Surgical Sutures; Guidance for Industry and...
Horisberger, Karoline; Beldi, Guido; Candinas, Daniel
Closure of loop ileostomy can be safely performed using sutures or staplers. The aim of the present study was to compare the cost effectiveness of three different techniques. A total of 128 consecutive patients who underwent closure of loop ileostomy between January 2002 and December 2008 were analyzed retrospectively. The primary outcome parameter was operative cost. Closure of ileostomy was performed in 66 patients with hand-sewn anastomosis, in 25 patients with stapler only, and in 37 patients with a combination of stapler and suture. There were no differences in terms of early and late postoperative complications. Operative time was significantly longer for "suture only" (101.4 ± 26 min) than for "stapler/suture" (-4.9 min) and "stapler only" (-17.8 min); the difference between the three groups is significant (p = 0.05). Duration of hospital stay was not different among the three groups. Operative costs with "stapler/suture" (1,755.9 ± 355.6 EUR) were significantly higher than with "suture only" (-254 EUR; p = 0.001) and "stapler only" (-236 EUR; p = 0.005). Operative time using the stapler only is significantly shorter than with hand-sewn anastomosis or combinations of stapler and suture. Operative costs are significantly higher for a procedure that includes suture and stapler.
Stockley, I; Elson, R A
A disposable skin stapler (Elite: Auto Suture UK Ltd) and Nylon vertical mattress sutures have been used for skin closure. The complications related to each method were evaluated in 129 wounds. There was a higher incidence of inflammation, discomfort on removal and spreading of the healing scar associated with staples. The only advantage of staples was speed of wound closure.
Murtha, Amy P; Kaplan, Andrew L; Paglia, Michael J; Mills, Benjie B; Feldstein, Michael L; Ruff, Gregory L
Suture knots present several disadvantages in wound closure, because they are tedious to tie and place ischemic demands on tissue. Bulky knots may be a nidus for infection, and they may extrude through skin weeks after surgery. Needle manipulations during knot-tying predispose the surgeon to glove perforation. A barbed suture was developed that is self-anchoring, requiring no knots or slack management for wound closure. The elimination of knot tying may have advantages over conventional wound closure methods. This prospective, randomized, controlled trial was designed to show that the use of barbed suture in dermal closure of the Pfannenstiel incision during nonemergent cesarean delivery surgery produces scar cosmesis at 5 weeks that is no worse than that observed with conventional closure using 3-0 polydioxanone suture. Cosmesis was assessed by review of postoperative photographs by a blinded, independent plastic surgeon using the modified Hollander cosmesis score. Secondary endpoints included infection, dehiscence, pain, closure time, and other adverse events. The study enrolled 195 patients, of whom 188 were eligible for analysis. Cosmesis scores did not significantly differ between the barbed suture group and the control group. Rates of infection, dehiscence, and other adverse events did not significantly differ between the two groups. Closure time and pain scores were comparable between the groups. The barbed suture represents an innovative option for wound closure. With a cosmesis and safety profile that is similar to that of conventional suture technique, it avoids the drawbacks inherent to suture knots.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonabsorbable poly(ethylene terephthalate... Devices § 878.5000 Nonabsorbable poly(ethylene terephthalate) surgical suture. (a) Identification. Nonabsorbable poly(ethylene terephthalate) surgical suture is a multifilament, nonabsorbable, sterile, flexible...
Johnson, Amy S; Ellers, Olaf; Lemire, Jim; Minor, Melissa; Leddy, Holly A
The shape of sea urchins may be determined mechanically by patterns of force analogous to those that determine the shape of a water droplet. This mechanical analogy implies skeletal flexibility at the time of growth. Although comprised of many rigid calcite plates, sutural collagenous ligaments could confer such flexibility if the sutures between plates loosened and acted as joints at the time of growth. We present experimental evidence of such flexibility associated with weight gain and growth. Over 13-, 4-, and 2-week periods, fed urchins (Strongylocentrotus droebachiensis) gained weight and developed looser sutures than unfed urchins that maintained or lost weight. Further, skeletons of fed urchins force-relaxed more than did those of unfed urchins and urchins with loose sutures force-relaxed more than those with tight sutures. Urchins (Strongylocentrotus franciscanus) fed for two and a half weeks, gained weight, also had looser skeletons and deposited calcite at sutural margins, whereas unfed ones did not. In field populations of S. droebachiensis the percentage having loose sutures varied with urchin diameter and reflected their size-specific growth rate. The association between feeding, weight gain, calcite deposition, force relaxation and sutural looseness supports the hypothesis that urchins deform flexibly while growing, thus determining their drop-like shapes.
Sundararaj, Sharath; Slusarewicz, Paul; Brown, Matt; Hedman, Thomas
The most common mode of surgical repair of ruptured tendons and ligaments involves the use of sutures for reattachment. However, there is a high incidence of rerupture and repair failure due to pulling out of the suture material from the damaged connective tissue. The main goal of this research was to achieve a localized delivery of crosslinking agent genipin (GP) from rapid-release biodegradable coatings on sutures, for strengthening the repair of ruptured connective tissue. Our hypothesis is that GP released from the suture coating will lead to exogenous crosslinking of native connective tissue resulting in beneficial effects on clinically relevant mechanical parameters such as tear resistance, tissue strength, and energy required to rupture the tissue (toughness). Sutures were successfully coated with a biodegradable polymer layer loaded with the crosslinking agent genipin, without compromising the mechanical properties of the suture. The rapid-release of genipin was achieved under both in vitro and ex vivo conditions. Exogenous crosslinking using these genipin releasing sutures was demonstrated using equine tendons. The tendons treated with genipin releasing sutures showed significant improvement in failure load, energy required for pull-out failure, and stiffness. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2199-2205, 2017. © 2016 Wiley Periodicals, Inc.
This article describes an alternative suture technique for thoracotomy incisions. A modified mattress suture technique is used to fix the intercostal muscles. The described technique can prevent rib fractures and reduce the incidence of intercostal nerve injury. Also, this technique is easy to perform and is effective. Georg Thieme Verlag KG Stuttgart · New York.
Jiang, Huiyong; Hao, Xiuyan; Xin, Ying; Pan, Youzhen
To compare the clinical outcomes of multipoint umbrella suture and single-purse suture with two-point traction after procedure for prolapse and hemorrhoids surgery (PPH) for the treatment of mixed hemorrhoids. Ninety patients were randomly divided into a PPH plus single-purse suture group (Group A) and a PPH plus multipoint umbrella suture (Group B). All operations were performed by an experienced surgeon. Operation time, width of the specimen, hemorrhoids retraction extent, postoperative pain, postoperative bleeding, and length of hospitalization were recorded and compared. Statistical analysis was conducted by t-test and χ2 test. There were no significant differences in sex, age, course of disease, and degree of prolapse of hemorrhoids between the two groups. The operative time in Group A was significantly shorter than that in Group B (P < 0.05). However, the incidence rates of submucosal hematoma and incomplete hemorrhoid core retraction were significantly lower in Group B (P < 0.05), whereas the width of the specimens in Group B was greater than that in Group A (P < 0.05). There were fewer redundant skin tags in Group B at three months follow-up. No significant difference in postoperative pain, postoperative bleeding, and time of hospital stay (P > 0.05 for all comparisons) was observed. The multipoint umbrella suture showed better clinical outcomes because of its targeted suture according to the extent of hemorrhoid prolapse. Copyright © 2017. Published by Elsevier Ltd.
Kerstein, Ryan L; Sedaghati, Tina; Seifalian, Alexander M; Kang, Norbert
Hypospadias is the most common congenital condition affecting between 1 in 250 and 300 live births. Even in experienced hands, surgery to repair this congenital defect can have a high complication rate. Wound dehiscence is reported to occur in 5% and fistula formation in 6%-40% depending on technique. The choice of suture material has been shown to affect the complication rate although there is (currently) no consensus about the best suture material to use. Ideally, the sutures used for urethroplasty should be absorbable while maintaining sufficient mechanical strength to support the wounds until they are self-supporting and able to resist urinary flow. Previous studies have compared the effects of human urine on different suture materials especially catgut. However, catgut is now banned in Europe. Our study examined the tensile and breaking strength as well as rate of degradation for four types of absorbable suture now commonly used for hypospadias repairs in the UK. We examined the effect of prolonged storage (up to 27 days) in human urine on 6/0 gauge Vicryl, Vicryl Rapide, Monocryl and polydioxanone (PDS) sutures. These four suture materials are commonly used by the senior plastic consultant surgeon (NK) for hypospadias repairs. 50 mm sections of these suture materials were stored in either urine or saline as control. At specified time points, each suture was placed in a uniaxial load testing machine to assess the stress-strain profile and the mechanical load required to break the suture was measured. Exposure to urine reduced the tensile and breaking strength of all the suture materials tested. PDS demonstrated the greatest resilience. Vicryl Rapide was the weakest suture and degraded completely by day 6. Vicryl and Monocryl had similar degradation profiles, but Vicryl retained more of its tensile strength for longer. There is a balance to be struck between the duration that a suture material must remain in any surgical wound and the risk that it causes
Cray, James; Meindl, Richard S; Sherwood, Chet C; Lovejoy, C Owen
The order in which ectocranial sutures undergo fusion displays species-specific variation among primates. However, the precise relationship between suture closure and phylogenetic affinities is poorly understood. In this study, we used Guttman Scaling to determine if the modal progression of suture closure differs among Homo sapiens, Pan troglodytes, and Gorilla gorilla. Because DNA sequence homologies strongly suggest that P. troglodytes and Homo sapiens share a more recent common ancestor than either does with G. gorilla, we hypothesized that this phylogenetic relationship would be reflected in the suture closure patterns of these three taxa. Results indicated that while all three species do share a similar lateral-anterior closure pattern, G. gorilla exhibits a unique vault pattern, which, unlike humans and P. troglodytes, follows a strong posterior-to-anterior gradient. P. troglodytes is therefore more like Homo sapiens in suture synostosis. Copyright 2008 Wiley-Liss, Inc.
Angelieri, Fernanda; Franchi, Lorenzo; Cevidanes, Lucia H S; McNamara, James A
The aim of this study was to analyze the diagnostic performance of the cervical vertebral maturation (CVM) method in estimating accurately the stages of maturation of the midpalatal suture. Cone-beam computed tomography (CBCT) images from 142 subjects (84 female, 58 male; mean age, 14.8 ± 9.7 years) were analyzed by 2 calibrated examiners to define, by visual analysis, the maturational stages of the cervical vertebrae and the midpalatal suture. These CBCT images were required by orthodontists and surgeons for diagnosis and treatment purposes. Positive likelihood ratios (LHRs) were calculated to evaluate the diagnostic performance of the CVM stages in identifying the maturational stages of the midpalatal suture. Positive LHRs greater than 10 were found for several cervical vertebral stages (CSs), including CS1 and CS2 for the identification of midpalatal suture stages A and B, CS3 for the diagnosis of midpalatal suture stage C, and CS5 for the assessment of midpalatal suture stages D and E. These positive LHRs indicated large and often conclusive increases in the likelihood that the CVM stages were associated with specific stages of midpalatal suture maturation. At CS4, there were a moderate positive LHR for stage C and low positive LHRs for stages D and E. Most CVM stages can be used for the diagnosis of the stages of maturation of the midpalatal suture, so that CBCT imaging may not be necessary in these patients. In the postpubertal period, however, an assessment of the midpalatal suture maturation using CBCT images may be indicated in deciding between conventional rapid maxillary expansion and surgically assisted rapid maxillary expansion. On the other hand, if the CVM stage cannot be assessed, chronologic age may be a viable alternative to predict some midpalatal suture stages (particularly the early stages). Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.
Kearney, C M; Buckley, C T; Jenner, F; Moissonnier, P; Brama, P A J
Selection of suture material in equine surgery is often based on costs or subjective factors, such as the surgeon's personal experience, rather than objective facts. The amount of objective data available on durability of suture materials with regard to specific equine physiological conditions is limited. To evaluate the effect of various equine physiological and pathological fluids on the rate of degradation of a number of commonly used suture materials. In vitro material testing. Suture materials were exposed in vitro to physiological fluid, followed by biomechanical analysis. Three absorbable suture materials, glycolide/lactide copolymer, polyglactin 910 and polydioxanone were incubated at 37°C for 7, 14 or 28 days in phosphate-buffered saline, equine serum, equine urine and equine peritoneal fluid from an animal with peritonitis. Five strands of each suture material type were tested to failure in a materials testing machine for each time point and each incubation medium. Yield strength, strain and Young's modulus were calculated, analysed and reported. For all suture types, the incubation time had a significant effect on yield strength, percentage elongation and Young's modulus in all culture media (P<0.0001). Suture type was also shown significantly to influence changes in each of yield strength, percentage elongation and Young's modulus in all culture media (P<0.0001). While the glycolide/lactide copolymer demonstrated the highest Day 0 yield strength, it showed the most rapid degradation in all culture media. For each of the 3 material characteristics tested, polydioxanone showed the least variation across the incubation period in each culture medium. The duration of incubation and the type of fluid have significant effects on the biomechanical properties of various suture materials. These findings are important for evidence-based selection of suture material in clinical cases. © 2013 EVJ Ltd.
Fares, U; Mokashi, A A; Elalfy, M S; Dua, H S
Aims In a previous study, we proposed that corneal topography performed 30–40 min after the initial suture removal can identify the next set of sutures requiring removal, for the treatment of post-keratoplasty astigmatism. The aim of this study was to evaluate the effect of removing subsequent sets of sutures at the same sitting. Methods 10/0 nylon interrupted sutures were placed, to secure the graft–host junction, at the time of keratoplasty. Topography was performed using Pentacam (Oculus) before suture removal. The sutures to be removed in the steep semi-meridians were identified and removed at the slit-lamp biomicroscope. Topography was repeated 30–40 min post suture removal, the new steep semi-meridians determined, and the next set of sutures to be removed were identified and removed accordingly. Topography was repeated 4–6 weeks later and the magnitude of topographic astigmatism was recorded. A paired-samples t-test was used to evaluate the impact of selective suture removal on reducing the magnitude of topographic and refractive astigmatism. Results Twenty eyes of 20 patients underwent sequential selective same-day suture removal (SSSS) after corneal transplantation. This study showed that the topographic astigmatism decreased by about 46.7% (3.68 D) and the refractive astigmatism decreased by about 37.7% (2.61 D) following SSSS. Vector calculations also show a significant reduction of both topographic and refractive astigmatism (P<0.001). Conclusion SSSS may help patients to achieve satisfactory vision more quickly and reduce the number of follow-up visits required post keratoplasty. PMID:23743526
Poppas, D P; Klioze, S D; Uzzo, R G; Schlossberg, S M
Laser tissue welding in genitourinary reconstructive surgery has been shown in animal models to decrease operative time, improve healing, and decrease postoperative fistula formation when compared with conventional suture controls. Although the absence of suture material is the ultimate goal, this has not been shown to be practical with current technology for larger repairs. Therefore, suture-assisted laser tissue welding will likely be performed. This study sought to determine the optimal suture to be used during laser welding. The integrity of various organic and synthetic sutures exposed to laser irradiation were analyzed. Sutures studied included gut, clear Vicryl, clear polydioxanone suture (PDS), and violet PDS. Sutures were irradiated with a potassium titanyl phosphate (KTP)-532 laser or an 808-nm diode laser with and without the addition of a light-absorbing chromophore (fluorescein or indocyanine green, respectively). A remote temperature-sensing device obtained real-time surface temperatures during lasing. The average temperature, time, and total energy at break point were recorded. Overall, gut suture achieved significantly higher temperatures and withstood higher average energy delivery at break point with both the KTP-532 and the 808-nm diode lasers compared with all other groups (P < 0.05). Both chromophore-treated groups had higher average temperatures at break point combined with lower average energy. The break-point temperature for all groups other than gut occurred at 91 degrees C or less. The optimal temperature range for tissue welding appears to be between 60 degrees and 80 degrees C. Gut suture offers the greatest margin of error for KTP and 808-nm diode laser welding with or without the use of a chromophore.
Shi, Brendan Y; Diaz, Miguel; Belkoff, Stephen M; Srikumaran, Uma
Obtaining strong fixation in low-density bone is increasingly critical in surgical repair of rotator cuff tears because of the aging population. To evaluate two new methods of improving pullout strength of transosseous rotator cuff repair in low-density bone, we analyzed the effects of 1) using 2-mm suture tape instead of no. 2 suture and 2) augmenting the lateral tunnel with cement. Eleven pairs of osteopenic or osteoporotic cadaveric humeri were identified by dual-energy x-ray absorptiometry. One bone tunnel and one suture were placed in the heads of 22 specimens. Five randomly selected pairs were repaired with no. 2 suture; the other six pairs were repaired with 2-mm suture tape. One side of each pair received lateral tunnel cement augmentation. Specimens were tested to suture pullout. Data were fitted to multivariate models that accounted for bone mineral density and other specimen characteristics. Two specimens were excluded because of knot-slipping during testing. Use of suture tape versus no. 2 suture conferred a 75-N increase (95% CI: 37, 113) in pullout strength (P<0.001). Cement augmentation conferred a 42-N improvement (95% CI: 10, 75; P=0.011). Other significant predictors of pullout strength were age, sex, and bone mineral density. We show two methods of improving the fixation strength of transosseous rotator cuff repairs in low-density bone: using 2-mm suture tape instead of no. 2 suture and augmenting the lateral tunnel with cement. These methods may improve the feasibility of transosseous repairs in an aging patient population. Copyright © 2017 Elsevier Ltd. All rights reserved.
Fares, U; Mokashi, A A; Elalfy, M S; Dua, H S
In a previous study, we proposed that corneal topography performed 30-40 min after the initial suture removal can identify the next set of sutures requiring removal, for the treatment of post-keratoplasty astigmatism. The aim of this study was to evaluate the effect of removing subsequent sets of sutures at the same sitting. 10/0 nylon interrupted sutures were placed, to secure the graft-host junction, at the time of keratoplasty. Topography was performed using Pentacam (Oculus) before suture removal. The sutures to be removed in the steep semi-meridians were identified and removed at the slit-lamp biomicroscope. Topography was repeated 30-40 min post suture removal, the new steep semi-meridians determined, and the next set of sutures to be removed were identified and removed accordingly. Topography was repeated 4-6 weeks later and the magnitude of topographic astigmatism was recorded. A paired-samples t-test was used to evaluate the impact of selective suture removal on reducing the magnitude of topographic and refractive astigmatism. Twenty eyes of 20 patients underwent sequential selective same-day suture removal (SSSS) after corneal transplantation. This study showed that the topographic astigmatism decreased by about 46.7% (3.68 D) and the refractive astigmatism decreased by about 37.7% (2.61 D) following SSSS. Vector calculations also show a significant reduction of both topographic and refractive astigmatism (P<0.001). SSSS may help patients to achieve satisfactory vision more quickly and reduce the number of follow-up visits required post keratoplasty.
Huntington, Lachlan; Richardson, Martin; Sobol, Tony; Caldow, Jonathon; Ackland, David C
Double-row rotator cuff tendon repair techniques may provide superior contact area and strength compared with single-row repairs, but are associated with higher material expenses and prolonged operating time. The purpose of this study was to evaluate gap formation, ultimate tensile strength and stiffness of a single-row cruciate suture rotator cuff repair construct, and to compare these results with those of the Mason-Allen and SutureBridge repair constructs. Infraspinatus tendons from 24 spring lamb shoulders were harvested and allocated to cruciate suture, Mason-Allen and SutureBridge repair groups. Specimens were loaded cyclically between 10 and 62 N for 200 cycles, and gap formation simultaneously measured using a high-speed digital camera. Specimens were then loaded in uniaxial tension to failure, and construct stiffness and repair strength were evaluated. Gap formation in the cruciate suture repair was significantly lower than that of the Mason-Allen repair (mean difference = 0.6 mm, P = 0.009) and no different from that of the SutureBridge repair (P > 0.05). Both the cruciate suture repair (mean difference = 15.7 N/mm, P = 0.002) and SutureBridge repair (mean difference = 15.8 N/mm, P = 0.034) were significantly stiffer than that of the Mason-Allen repair; however, no significant differences in ultimate tensile strength between repair groups were discerned (P > 0.05). The cruciate suture repair construct, which may represent a simple and cost-effective alternative to double-row and double-row equivalent rotator cuff repairs, has comparable biomechanical strength and integrity with that of the SutureBridge repair, and may result in improved construct longevity and tendon healing compared with the Mason-Allen repair. © 2017 Royal Australasian College of Surgeons.
Krepel, Candace J.; Marks, Richard M.; Rossi, Peter J.; Sanger, James; Goldblatt, Matthew; Graham, Mary Beth; Rothenburger, Stephen; Collier, John; Seabrook, Gary R.
Sutures under selective host/environmental factors can potentiate postoperative surgical site infection (SSI). The present investigation characterized microbial recovery and biofilm formation from explanted absorbable (AB) and nonabsorbable (NAB) sutures from infected and noninfected sites. AB and NAB sutures were harvested from noninfected (70.9%) and infected (29.1%) sites in 158 patients. At explantation, devices were sonicated and processed for qualitative/quantitative bacteriology; selective sutures were processed for scanning electron microscopy (SEM). Bacteria were recovered from 85 (53.8%) explanted sites; 39 sites were noninfected, and 46 were infected. Suture recovery ranged from 11.1 to 574.6 days postinsertion. A significant difference in mean microbial recovery between noninfected (1.2 isolates) and infected (2.7 isolates) devices (P < 0.05) was noted. Staphylococcus epidermidis, Staphylococcus aureus, coagulase-negative staphylococci (CNS), Peptostreptococcus spp., Bacteroides fragilis, Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa, and Serratia spp. were recovered from infected devices, while commensal skin flora was recovered from noninfected devices. No significant difference in quantitative microbial recovery between infected monofilament and multifilament sutures was noted. Biofilm was present in 100% and 66.6% of infected and noninfected devices, respectively (P < 0.042). We conclude that both monofilament and braided sutures provide a hospitable surface for microbial adherence: (i) a significant difference in microbial recovery from infected and noninfected sutures was noted, (ii) infected sutures harbored a mixed flora, including multidrug-resistant health care-associated pathogens, and (iii) a significant difference in the presence or absence of a biofilm in infected versus noninfected explanted devices was noted. Further studies to document the benefit of focused risk reduction strategies to minimize suture contamination and
Chen, Y.; Gu, Y. J.; Currie, C. A.; Johnston, S. T.; Hung, S. H.; Schaeffer, A. J.; Audet, P.
The North American Cordillera is a Phanerozoic orogenic belt that extends from Mexico to Alaska. Its eastern boundary is marked by pronounced changes in geophysical observations (e.g., mantle seismic velocity, surface heat flow, and effective elastic thickness) indicating a steep structural gradient beneath the Cordilleran foreland and the adjacent North American Craton. Seismological constraints on this boundary zone have been highly uneven: on the one hand, the knowledge of subsurface structures of the US Cordillera has been greatly enhanced by the USArray; on the other hand, detailed surveys of the northern counterpart, the Canadian Cordillera, are limited due to relatively sparse broadband data coverage. Questions pertaining to where and how Cordillera-Craton transition occurs in the upper mantle remain debated. Here, we utilize new teleseismic travel-time data from recently deployed networks in the Alberta foreland basin and nearby USArray stations and invert for mantle seismic velocities using finite-frequency tomography. The resulting high-resolution 3D model shows a dramatic increase in lithosphere thickness (>200 km) from the Cordillera to Craton. Additionally, independent calculations of mantle temperature from P (4.3%) and S (7.0%) velocity contrasts yield a consistent eastward 200-300 °C decrease at 150 km depth. We attribute the sharp structural and temperature/velocity gradients to the Cordillera-Craton boundary (CCB) established since at least the Late Cretaceous (ca. 100 Ma). The CCB dips steeply to the west beneath a carbonate belt that delineates a cryptic orogenic suture near the southern Rocky Mountain Trench, which provides strong evidence for an upper mantle suture between North America and an allochthonous Cordillera. The westward-dipping CCB may be a preserved structure associated with partial subduction of the leading edge of the North American Craton during its terminal collision with a microcontinent (Cordillera); this would require a
Bianchi, Irene; Bokelmann, Götz
The upper crust of the KTB (Kontinentales Tiefbohrprogramm) area in Southeastern Germany is a focal point for the Earth Science community due to the huge amount of information collected throughout the last thirty years. In this study we explore the crustal structure of the KTB area through the application of the receiver function (RF) technique to a new data set recorded by 9 temporary seismic stations and 1 permanent station. We aim to unravel the isotropic structure and compare our results with previous information from the reflection profiles collected during the initial site investigations. Due to the large amount of information collected by previous studies, in terms of P-wave velocity, depth and location of major reflectors, depth reconstruction of major faults zones, this area represents a unique occasion to test the resolution capability of a passive seismological study performed by the application of the RF. We aim to verify which contribution could be given by the application of the receiver functions technique, for future studies, in order to get clear images of the deep structure, and up to which resolution. The RF technique has apparently not been applied in the area before, yet it may give useful additional insight in subsurface structure, particularly at depths larger than the maximum depth reached by drilling, but also on structures in the upper crust, around the area that has been studied in detail previously. In our results vS-depth profiles for stations located on the same geological units display common features and show shallow S-wave velocities typical of the outcropping geological units (i.e. sedimentary basin, granites, metamorphic rocks). At around 10 km depth we observe a strong velocity increase beneath all stations. For the stations located in the center of the area, this variation is weaker, which we assume to be the signature of the main tectonic suture in the area (i.e. the Saxothuringian-Moldanubian suture), along an West
Bianchi, Irene; Bokelmann, Götz
The upper crust of the KTB (Kontinentales Tiefbohrprogramm) area in the Southeastern Germany is a focal point for the Earth Science community due to the huge amount of information collected throughout the last 30 yr. In this study, we explore the crustal structure of the KTB area through the application of the Receiver Function (RF) technique to a new data set recorded by nine temporary seismic stations and one permanent station. We aim to unravel the isotropic structure and compare our results with previous information from the reflection profiles collected during the initial site investigations. Due to the large amount of information collected by previous studies, in terms of P-wave velocity, depth and location of major reflectors, depth reconstruction of major faults zones, this area represents a unique occasion to test the resolution capability of a passive seismological study performed by the application of the RF. We aim to verify which contribution could be given by the application of the RF technique, for future studies, in order to get clear images of the deep structure and up to which resolution. The RF technique has apparently not been applied in the area before, yet it may give useful additional insight in subsurface structure, particularly at depths larger than the maximum depth reached by drilling, but also on structures in the upper crust, around the area that has been studied in detail previously. In our results vS-depth profiles for stations located on the same geological units display common features and show shallow S-wave velocities typical of the outcropping geological units (i.e. sedimentary basin, granites and metamorphic rocks). At around 10 km depth, we observe a strong velocity increase beneath all stations. For the stations located in the centre of the area, this variation is weaker, which we assume to be the signature of the main tectonic suture in the area (i.e. the Saxothuringian-Moldanubian suture), along a west-to-east extended
Sanchez, Anthony; Ferrari, Marcio B; Frangiamore, Salvatore J; Sanchez, George; Kruckeberg, Bradley M; Provencher, Matthew T
Although injuries of the pectoralis major muscle are generally uncommon, ruptures of the pectoralis major are occasionally seen in younger, more active patients who participate in weightlifting activities. These injuries usually occur during maximal contraction of the muscle, while in extension and external rotation. In the case of a rupture, operative treatment is advocated especially in young, active patients regardless of the chronicity of the injury. Various surgical techniques for reattachment of the avulsed tendon have been described, but bone tunnel and suture anchor repair techniques are most widely used. In this Technical Note, we present our preferred technique for acute pectoralis major rupture repair involving use of cortical buttons for tendon stump-to-bone fixation.
Bilgic, Elif; Endo, Satoshi; Lebedeva, Ekaterina; Takao, Madoka; McKendy, Katherine M; Watanabe, Yusuke; Feldman, Liane S; Vassiliou, Melina C
A needs assessment identified a gap in teaching and assessment of laparoscopic suturing (LS) skills. The purpose of this review is to identify assessment tools that were used to assess LS skills, to evaluate validity evidence available, and to provide guidance for selecting the right assessment tool for specific assessment conditions. Bibliographic databases were searched till April 2017. Full-text articles were included if they reported on assessment tools used in the operating room/simulation to (1) assess procedures that require LS or (2) specifically assess LS skills. Forty-two tools were identified, of which 26 were used for assessing LS skills specifically and 26 for procedures that require LS. Tools had the most evidence in internal structure and relationship to other variables, and least in consequences. Through identification and evaluation of assessment tools, the results of this review could be used as a guideline when implementing assessment tools into training programs.
Oquendo, Yousi A; Riddle, Elijah W; Hiller, Dennis; Blinman, Thane A; Kuchenbecker, Katherine J
Minimally invasive surgeons must acquire complex technical skills while minimizing patient risk, a challenge that is magnified in pediatric surgery. Trainees need realistic practice with frequent detailed feedback, but human grading is tedious and subjective. We aim to validate a novel motion-tracking system and algorithms that automatically evaluate trainee performance of a pediatric laparoscopic suturing task. Subjects (n = 32) ranging from medical students to fellows performed two trials of intracorporeal suturing in a custom pediatric laparoscopic box trainer after watching a video of ideal performance. The motions of the tools and endoscope were recorded over time using a magnetic sensing system, and both tool grip angles were recorded using handle-mounted flex sensors. An expert rated the 63 trial videos on five domains from the Objective Structured Assessment of Technical Skill (OSATS), yielding summed scores from 5 to 20. Motion data from each trial were processed to calculate 280 features. We used regularized least squares regression to identify the most predictive features from different subsets of the motion data and then built six regression tree models that predict summed OSATS score. Model accuracy was evaluated via leave-one-subject-out cross-validation. The model that used all sensor data streams performed best, achieving 71% accuracy at predicting summed scores within 2 points, 89% accuracy within 4, and a correlation of 0.85 with human ratings. 59% of the rounded average OSATS score predictions were perfect, and 100% were within 1 point. This model employed 87 features, including none based on completion time, 77 from tool tip motion, 3 from tool tip visibility, and 7 from grip angle. Our novel hardware and software automatically rated previously unseen trials with summed OSATS scores that closely match human expert ratings. Such a system facilitates more feedback-intensive surgical training and may yield insights into the fundamental
Acharyya, S. K.
Dismembered late Mesozoic ophiolites occur in two parallel belts along the eastern margin of the Indian Plate. The Eastern Belt, closely following the magmatic arc of the Central Burma Basin, coincides with a zone of high gravity. It is considered to mark a zone of steeply dipping mafic-ultramafic rocks and continental metamorphic rocks, which are the locus of two closely juxtaposed sutures. In contrast, the Western Belt, which follows the eastern margin of the Indo-Burma Range and the Andaman outer-island-arc, broadly follows a zone of negative gravity anomalies. Here the ophiolites occur mainly as rootless subhorizontal bodies overlying Eocene-Oligocene flyschoid sediments. Two sets of ophiolites that were accreted during the Early Cretaceous and mid-Eocene are juxtaposed in this belt. These are inferred to be westward propagated nappes from the Eastern Belt, emplaced during the late Oligocene collision between the Burmese and Indo-Burma-Andaman microcontinents. Ophiolite occurrences in the Andaman Islands belong to the Western Belt and are generally interpreted as upthrust oceanic crust, accreted due to prolonged subduction activity to the west of the island arc. This phase of subduction began only in the late Miocene and thus could not have produced the ophiolitic rocks, which were accreted in the late Early Eocene.
Thomas, William A.; Powell, Christine A.
The cause of intraplate seismic zones persists as an important scientific and societal question. Most intraplate earthquakes are concentrated in specific seismic zones along or adjacent to large-scale basement structures (e.g., rifts or sutures at ancient plate boundaries) within continental crust. The major intraplate seismic zones are limited to specific segments and are not distributed along the lengths of the ancient structures. We present a new hypothesis that major intraplate seismic zones are restricted to places where concentrated crustal deformation (CCD) is overprinted on large-scale basement structures. Examples where CCD affects the stability of specific parts of large-scale structures in response to present-day stress conditions include the most active seismic zones in central and eastern North America: Charlevoix, Eastern Tennessee, and New Madrid. Our hypothesis has important implications for the assessment of seismic hazards.
Barber, F Alan; Herbert, Morley A; Schroeder, F Alexander; Aziz-Jacobo, Jorge; Mays, Matthew M; Rapley, Jay H
To evaluate the strength and suture-tendon interface security of various suture anchors triply and doubly loaded with ultrahigh-molecular weight polyethylene-containing sutures and to evaluate the relative effectiveness of placing these anchors in a single-row or double-row arrangement by cyclic loading and then destructive testing. The infraspinatus muscle was reattached to the original humeral footprint by use of 1 of 5 different repair patterns in 40 bovine shoulders. Two single-row repairs and three double-row repairs were tested. High-strength sutures were used for all repairs. Five groups were studied: group 1, 2 triple-loaded screw suture anchors in a single row with simple stitches; group 2, 2 triple-loaded screw anchors in a single row with simple stitches over a fourth suture passed perpendicularly ("rip-stop" stitch); group 3, 2 medial and 2 lateral screw anchors with a single vertical mattress stitch passed from the medial anchors and 2 simple stitches passed from the lateral anchors; group 4, 2 medial double-loaded screw anchors tied in 2 mattress stitches and 2 push-in lateral anchors capturing the medial sutures in a "crisscross" spanning stitch; and group 5, 2 medial double-loaded screw anchors tied in 2 mattress stitches and 2 push-in lateral anchors creating a "suture-bridge" stitch. The specimens were cycled between 10 and 180 N at 1.0 Hz for 3,500 cycles or until failure. Endpoints were cyclic loading displacement (5 and 10 mm), total displacement, and ultimate failure load. A single row of triply loaded anchors was more resistant to stretching to a 5- and 10-mm gap than the double-row repairs with or without the addition of a rip-stop suture (P < .05). The addition of a rip-stop stitch made the repair more resistant to gap formation than a double row repair (P < .05). The crisscross double row created by 2 medial double-loaded suture anchors and 2 lateral push-in anchors stretched more than any other group (P < .05). Double-row repairs with
Cox, Joseph T; Shorten, Peter L; Gould, Gregory C; Markert, Ronald J; Barnett, Michael D; Laughlin, Richard T
Surgical treatment of insertional Achilles tendinopathy often involves detachment and debridement of the Achilles tendon insertion. A recent study has shown that knotted suture bridge fixation of the Achilles to the calcaneus is biomechanically superior to single-row fixation, but there is an absence of literature on the use of different suture bridge constructs to repair the Achilles tendon. There will be no significant difference in the load to failure, mode of failure, tendon strain, tendon stiffness, repair site gapping, or footprint size when comparing knotted suture bridge repair to knotless suture bridge repair of the Achilles tendon after detachment for insertional Achilles tendinopathy. Controlled laboratory study. A single specimen from each pair of 10 cadaveric Achilles tendons was randomized to 1 of 2 Achilles insertion repair groups: knotted (n = 10) or knotless (n = 10) suture bridge repair. Repaired footprint size was measured, and then cyclic testing from 10 to 100 N for 2000 cycles was performed. This was followed by measurement of tendon strain, repair site displacement, load to failure, and tendon stiffness. The knotted suture bridge repair had a significantly higher load to failure compared with the knotless suture bridge (mean ± SD, 317.8 ± 93.6 N vs 196.1 ± 12.1 N, respectively; P = .001). All constructs failed at the tendon-suture interface. Tendon strain after cyclic testing was significantly greater in the knotless (1.20 ± 1.05) compared with the knotted (0.39 ± 0.4) suture repair groups (P = .011). There was no significant difference in footprint size between the knotted (230.3 ± 63.3 mm(2)) and knotless (248.5 ± 48.8 mm(2)) groups (P = .40). There was also no significant difference in stiffness (knotted = 76.4 ± 8.0 N/mm; knotless = 69.6 ± 10.9 N/mm; P = .17) and repair site displacement after cyclic testing (knotted = 2.8 ± 1.2 mm; knotless = 3.6 ± 1.1 mm; P = .17). During suture bridge repair of the Achilles tendon after
Balica, C.; Hann, H. P.; Chen, F.; Balintoni, I. C.; Zaharia, L.
The Southern Carpathians, as an Alpine chain are formed of two domains, namely the Getic Domain (GD) and the Danubian Domain (DD). The basement of DD is represented by two terranes, named Dragsan and Lainici- Paius sutured through Tisovita-Iuti ophiolitic complex. The two terranes were invaded by large granitic plutons, some of them being dated as Late Proterozoic by U/Pb method. Yet, along the inferred suture there are four granitic bodies whose ages have been only assumed by their geological relations. From North to South the four bodies sampled for LA-ICP-MS zircon U/Pb dating are: Muntele Mic, Sfardinu, Cherbelezu and Ogradena. The previously CL imaged zircon crystals were ablated at the China's University of Geosciences facilities in Wuhan. The zircons from all samples showed quite complex structures, with many inherited cores or affected by lead loss processes. In order to get a mean age for every pluton, we used the weighted average plots by projecting the 206Pb/238U apparent ages. The crystallization age of the Poiana Marului pluton is around 326.7±7 Ma (MSWD 1.6). A set of sixteen apparent ages ranging between 400 to 648 Ma together with other tree points indicating 897, 1353 and 1693 Ma, represent inheritances. There was no observable lead loss process in this data set. The Sfardinu granite crystallized at 310±7.9 Ma (MSWD 4.8). The inheritances found in this sample are at 427 and 723 Ma, but an important lead loss process occurred later, as indicated by ten apparent ages between 240-292 Ma. Cherbelezu granite gave a crystallization mean age of 326.9±4.9 Ma (MSWD 1.9). A single inherited core appears at 502 Ma, yet eight apparent ages ranging between 239-295 Ma signalize again an important lead loss process. Other two ages at 176 and 193 Ma confirm the presence of this process. The Ogradena pluton zircons display two possible crystallization ages for the outer zones of zircon grains, at 356.6±7.8 Ma (twelve apparent ages, MSWD 12) and 314.1±7.8 Ma
Stick, J A; Krehbiel, J D; Kunze, D J; Wortman, J A
Esophageal healing was evaluated in 10 ponies after sutured and nonsutured cervical esophagotomy techniques. Mucosal healing occurred significantly (P less than 0.005) faster after sutured esophagotomies (x = 7.5 days after surgery) than after nonsutured esophagotomies (x = 25.6 days after surgery), based on endoscopic and clinical evaluations. Although endoscopy was an accurate assessment of the return of normal passage of a food bolus through the esophagus, 4 of 10 ponies had radiographic evidence of a sinus tract after the mucosa was considered healed, based on endoscopic and clinical examinations. The surgical skin wound also healed significantly sooner after sutured esophagotomies (x = 10 days) than after nonsutured esophagotomies (x = 33.4 days). A traction diverticulum developed in all ponies with nonsutured esophagotomies, but occurred in only 1 pony with sutured esophagotomy. Minor complications were seen more frequently with sutured esophagotomy than with a nonsutured esophagotomy, but were resolved with local therapy. Saliva appeared to inhibit wound healing. All ponies were fed through esophagostomy tubes until the mucosa at the esophagotomy site was considered healed. Except for 1 sutured esophagotomy that dehisced, sutured esophagotomy was superior to nonsutured esophagotomy, because earlier establishment of a mucosal seal resulted in more rapid healing and reduced nursing care.
Maksoud, Mohamed; Koo, Samuel; Barouch, Kasumi; Karimbux, Nadeem
The aim of the present study was to determine the favoritism of suture materials among a group of clinicians at a teaching institution. The surveys included 11 absorbable and nine non-absorbable sutures. The surveyor was asked to select his or her suture preferences when it comes to using it in 13 different, commonly-performed surgical procedures. The surveys showed overall preferences for non-absorbable versus absorbable sutures. Chromic Gut with a 4-0 diameter thread reverse cutting FS2 needle was the most favored suture. For periodontal bone grafts and hard tissue ridge augmentation, polytetrafluoroethylene with a 4-0 thread and FS2 needle was preferred. For autogenous gingival grafts, gingival allografts, connective tissue grafts, frenectomy and frenoplasty, Chromic Gut with 5-0 diameter thread reverse cutting P3 needle was favored. For extraction socket preservation, soft tissue canine exposure, ridge augmentation, and dental implants, Chromic Gut with 4-0 diameter thread reverse cutting FS2 needle was preferred, and for sinus augmentation, Vicryl with a 4-0 diameter thread reverse cutting FS2 needle was favored. Absorbable sutures were preferred in the majority of periodontal procedures; however, non-absorbable sutures were favored in procedures that required longer healing or better stability of the flap edges in cases of periodontal and ridge augmentation. © 2013 Wiley Publishing Asia Pty Ltd.
Kolt, Jeremy D
The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. Review was undertaken of the medical literature using the PubMed Internet database and cross-referencing major -articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op-site, staples, subcuticular suture, complication, infection and scars. Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape.
Pfaff, Miles J.; Xue, Ke; Li, Li; Horowitz, Mark C.; Steinbacher, Derek M.; Eswarakumar, Jacob V.P.
Fibroblast growth factor receptor 2 (FGFR2) signaling is critical for proper craniofacial development. A gain-of-function mutation in the 2c splice variant of the receptor’s gene is associated with Crouzon syndrome, which is characterized by craniosynostosis, the premature fusion of one or more of the cranial vault sutures, leading to craniofacial maldevelopment. Insight into the molecular mechanism of craniosynostosis has identified the ERK-MAPK signaling cascade as a critical regulator of suture patency. The aim of this study is to investigate the role of FGFR2c-induced ERK-MAPK activation in the regulation of coronal suture development. Loss-of-function and gain-of-function Fgfr2c mutant mice have overlapping phenotypes, including coronal synostosis and craniofacial dysmorphia. In vivo analysis of coronal sutures in loss-of-function and gain-of-function models demonstrated fundamentally different pathogenesis underlying coronal suture synostosis. Calvarial osteoblasts from gain-of-function mice demonstrated enhanced osteoblastic function and maturation with concomitant increase in ERK-MAPK activation. In vitro inhibition with the ERK protein inhibitor U0126 mitigated ERK protein activation levels with a concomitant reduction in alkaline phosphatase activity. This study identifies FGFR2c-mediated ERK-MAPK signaling as a key mediator of craniofacial growth and coronal suture development. Furthermore, our results solve the apparent paradox between loss-of-function and gain-of-function FGFR2c mutants with respect to coronal suture synostosis. PMID:27034231
Gonçalves, Antonio José; de Souza, J A L; Menezes, M B; Kavabata, N K; Suehara, A B; Lehn, C N
The extension of the surgery and closure type of the pharynx can be the determinants in the pharyngocutaneous fistula development. The objective of the study is to evaluate the incidence of pharingocutaneous salivary fistulae after total laryngectomies comparing manual and mechanical sutures. The study is designed as non-randomized, prospective clinical study. Sixty patients with squamous cell carcinoma were submitted to total laryngectomies. In 30 cases, the linear stapler (75 mm) closure (surgical technique described in details) and in other 30 cases manual suture was used. The cases of mechanical suture were prospective and consecutive and the cases of manual suture were a review series of patients who underwent a manual suture of pharynx, in the same period of time. The statistical analysis between the two groups concluded that both were comparable. Fistulae incidence was 6.7% (2/30) in the group with the mechanical suture and 36.7% (11/30) in the group with manual suture closure, presenting a significant difference (p = 0.0047). The total laryngectomy with mechanical closure is an easy and fast learning technique, allowing watertight closure of the pharynx with a low risk of contamination of the surgical field. It is an assured method, even in previously irradiated patients, since we respect the limits of its indication regarding the extension of primary tumor that must be confirmed by previous suspension laryngectomy performed in the operating room.
Parikh, Punam P; Tashiro, Jun; Wagenaar, Amy E; Curbelo, Miosotys; Perez, Eduardo A; Neville, Holly L; Hogan, Anthony R; Sola, Juan E
Appendiceal ligation during pediatric laparoscopic appendectomy (LA) may be performed using looped suture versus stapler. Controversy regarding the utility of either method exists. Clinical outcomes and cost analysis of LA with both methods were compared. All pediatric LA were performed from fiscal years 2013 and 2014 by two pediatric surgeons. While one surgeon used looped suture, the other used stapler exclusively. chi-Square tests were performed to analyze associations. Two hundred thirty-eight cases were analyzed where looped suture versus stapler LA was performed in 46% and 54% of patients, respectively. Operating room costs were $317.10 and $707.12/person for looped suture and stapler LA, respectively (P<0.0001). Difference in cost of $390.02/person was attributed solely to ligation type. On bivariate analysis, rate of in-hospital complications, length of stay, return-to-ER and readmission within 30 days did not significantly differ between groups. A comparative analysis of looped suture versus stapler device during LA for pediatric appendicitis revealed that postoperative complications, length of stay, ER visits and readmissions were not significantly different. Looped suture LA was significantly more cost efficient than stapler LA. In pediatric appendicitis, appendiceal ligation during LA may be performed safely and cost effectively with looped suture versus stapler. Cost effectiveness LEVEL OF EVIDENCE: III. Copyright © 2017 Elsevier Inc. All rights reserved.
Pfaff, Miles J; Xue, Ke; Li, Li; Horowitz, Mark C; Steinbacher, Derek M; Eswarakumar, Jacob V P
Fibroblast growth factor receptor 2 (FGFR2) signaling is critical for proper craniofacial development. A gain-of-function mutation in the 2c splice variant of the receptor's gene is associated with Crouzon syndrome, which is characterized by craniosynostosis, the premature fusion of one or more of the cranial vault sutures, leading to craniofacial maldevelopment. Insight into the molecular mechanism of craniosynostosis has identified the ERK-MAPK signaling cascade as a critical regulator of suture patency. The aim of this study is to investigate the role of FGFR2c-induced ERK-MAPK activation in the regulation of coronal suture development. Loss-of-function and gain-of-function Fgfr2c mutant mice have overlapping phenotypes, including coronal synostosis and craniofacial dysmorphia. In vivo analysis of coronal sutures in loss-of-function and gain-of-function models demonstrated fundamentally different pathogenesis underlying coronal suture synostosis. Calvarial osteoblasts from gain-of-function mice demonstrated enhanced osteoblastic function and maturation with concomitant increase in ERK-MAPK activation. In vitro inhibition with the ERK protein inhibitor U0126 mitigated ERK protein activation levels with a concomitant reduction in alkaline phosphatase activity. This study identifies FGFR2c-mediated ERK-MAPK signaling as a key mediator of craniofacial growth and coronal suture development. Furthermore, our results solve the apparent paradox between loss-of-function and gain-of-function FGFR2c mutants with respect to coronal suture synostosis. Copyright © 2016 Elsevier Inc. All rights reserved.
Callahan, Travis L; Lear, William; Kruzic, Jamie J; Maughan, Cory B
Surgeons can choose from a wide selection of commercially available suture brands, which come at a range of prices. There is currently limited evidence in the literature to guide this selection process. This investigation examined the breaking force, stress, and elongation of a variety of commercially available nylon sutures compared to their relative prices. Seven 5-0, nonabsorbable, nylon suture brands were tensile tested in straight, knotted and knot-security configurations according to the procedures outlined by the United States Pharmacopeia for the tensile testing of sutures. Covidien, the cheapest brand tested, had the highest failure load of straight and knot-security tests. Dafilon was found to have the highest breaking force and percent elongation of knot-pull tests. J&J Ethicon and Supramid had the highest percent elongation to failure for straight-pull and knot-security tests, respectively. This study was limited to specific in vitro tensile properties of nylon suture. Other factors affecting suture quality and price, such as needle properties, were not investigated. The data presented in the study provide information for guiding the selection and purchase of sutures according to tensile properties. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 815-819, 2017. © 2016 Wiley Periodicals, Inc.
Lee, Jae Hyung
Purpose To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery. Methods In a prospective trial, we performed strabismus surgery using limbal incisions. Conjunctival wounds were closed with fibrin glue in 20 eyes of 20 patients (fibrin group) and 8-0 polyglactin suture in 20 eyes of 20 patients (suture group). Postoperative pain, tearing, and inflammation were compared at 1 day, 1 week, 3 weeks, and 6 weeks after surgery. Conjunctival incision healing was also investigated. Results One day and one week post-operatively, pain and tearing scores were lower in the fibrin group (p = 0.000, respectively). Mean surgery time was significantly shorter in the fibrin (48 ± 5 minutes) than the suture group (63 ± 7 minutes) (p = 0.000). Inflammation was significantly more severe in the suture group until 3 weeks postoperative (p = 0.000, respectively), but conjunctival healing did not differ between the groups. Hyperemia appeared more prominent in the fibrin group 3 and 6 weeks after surgery (p = 0.087 and 0.000, respectively). Two eyes in the fibrin group showed conjunctival gaps of more than 2 mm, which closed spontaneously by three weeks after surgery. No allergic reactions or infections developed. Conclusions Fibrin glue proved to be as effective as sutures in closing conjunctival wounds. It provides more comfortable early postoperative courses and might be considered as an alternative to sutures in strabismus surgery. PMID:21655043
McComb, P F
A surgeon at University Hospital-Shaughnessy Site in Vancouver, British Columbia in Canada has used a new suturing instrument that enters the peritoneal cavity to permit microsutures of size 6-0 or less and 75 cm in length during laparoscopy. Surgeons can use this instrument to perform female sterilizations as well as removal of the gall gladder and appendix and repair of the bowel, bladder, and ureteric injuries. As of April 1992, the suturing instrument was not yet commercially available. It consists of a partial hollow 30 cm x 2 mm (inside diameter) tube with the end that does not enter the peritoneal cavity being occluded. The suturing instrument enters the peritoneal cavity via a standard 5 mm deflection valved trocar sleeve with a 3 mm reduction sleeve or with a 3 mm inside diameter occlusive rubber washer instead of the standard 5 mm washer. The suture must have sufficient tensile strength and have low coefficients for static and for sliding surface frictions. Once the suture and needle are inside the body, forceps which have entered via another cannula detach them from the suturing instrument. A 3 mm laproscopic needle driver replaces the suturing instrument at this point. The surgeon guides the needle through the intended tissues and then withdrawn with the needle driver through the 5 mm sleeve. The surgeon ties the knot outside the body and slides it down the length of the suture to apply it to the tissue. He/she repeats this 1 more time. Scissors inserted through the other opening then cut the suture. Once mastered, this process takes only a few minutes to complete. In all 11 cases or restoration of uterine tube patency done by the surgeon in Vancouver using the new technique, tubal patency has not been hindered. 2 assessed sterilization reversals have been successful.
Kiriyama, Yoshimori; Matsumoto, Hideo; Toyama, Yoshiaki; Nagura, Takeo
The aim of this study was to develop a new suture tension sensor for musculoskeletal soft tissue that shows deformation or movements. The suture tension sensor was 10 mm in size, which was small enough to avoid conflicting with the adjacent sensor. Furthermore, the sensor had good linearity up to a tension of 50 N, which is equivalent to the breaking strength of a size 1 absorbable suture defined by the United States Pharmacopeia. The design and mechanism were analyzed using a finite element model prior to developing the actual sensor. Based on the analysis, adequate material was selected, and the output linearity was confirmed and compared with the simulated result. To evaluate practical application, the incision of the skin and capsule were sutured during simulated total knee arthroplasty. When conventional surgery and minimally invasive surgery were performed, suture tensions were compared. In minimally invasive surgery, the distal portion of the knee was dissected, and the proximal portion of the knee was dissected additionally in conventional surgery. In the skin suturing, the maximum tension was 4.4 N, and this tension was independent of the sensor location. In contrast, the sensor suturing the capsule in the distal portion had a tension of 4.4 N in minimally invasive surgery, while the proximal sensor had a tension of 44 N in conventional surgery. The suture tensions increased nonlinearly and were dependent on the knee flexion angle. Furthermore, the tension changes showed hysteresis. This miniature tension sensor may help establish the optimal suturing method with adequate tension to ensure wound healing and early recovery.
Steinemann, D C; Limani, P; Ochsenbein, N; Krähenmann, F; Clavien, P-A; Zimmermann, R; Hahnloser, D
The objective of this study was to investigate the additional burdens in terms of pain, prolongation of surgery and morbidity which is added to elective caesarean section if umbilical hernia suture repair is performed simultaneously. Secondly, patient's satisfaction and hernia recurrence rate were assessed. Consecutive women with symptomatic umbilical hernia undergoing internal or external suture repair during elective caesarean were included in this retrospective cohort-control study. Data on post-operative pain, duration of surgery and morbidity of a combined procedure were collected. These patients were matched 1:10 to women undergoing caesarean section only. Additionally, two subgroups were assessed separately: external and internal suture hernia repair. These subgroups were compared for patient's satisfaction, cosmesis, body image and recurrence rate. Fourteen patients with a mean age of 37 years were analysed. Internal suture repair (n = 7) prolonged caesarean section by 20 min (p = 0.001) and external suture repair (n = 7) by 34 min (p < 0.0001). Suture repair did not increase morphine use (0.38 ± 0.2 vs. 0.4 ± 02 mg/kg body weight), had no procedure-related morbidity and prolonged hospitalization by 0.5 days (p = 0.01). At a median follow-up of 37 (5-125) months, two recurrences in each surgical technique, internal and external suture repair, occurred (28 %). Body image and cosmesis score showed a higher level of functioning in internal suture repair (p = 0.02; p = 0.04). Despite a high recurrence rate, internal suture repair of a symptomatic umbilical hernia during elective caesarean section should be offered to women if requested. No additional morbidity or scar is added to caesarean section. Internal repair is faster, and cosmetic results are better, additional skin or fascia dissection is avoided, and it seems to be as effective as an external approach. Yet, women must be informed on the high recurrence rate.
Eun, Sang Soo; Lee, Sang Ho; Sabal, Luigi Andrew
There are numerous methods for repairing posterior root tears of the medial meniscus (PRTMM). Repair techniques using suture anchors through a high posteromedial portal have been reported. The present study found that using a knotless suture anchor instead of suture anchor seemed easier and faster because it avoided passing the sutures through the meniscus and tying a knot in a small space. This study describes a knotless suture anchor technique through a high posteromedial portal, and its clinical results. Copyright © 2016 Elsevier B.V. All rights reserved.
Using the da Vinci single-site platform, surgeons can perform more minimally invasive surgery. However, surgical challenges exist due to the limitations of single-site instrumental movements. To aid in the performance of successful robotic single-site hysterectomy, a new suturing technique using the current set of limited instruments is introduced in this study. New vaginal cuff suturing techniques have been used in 55 robotic single-site hysterectomies in our institute over the past 2 years. A needle driver approach utilizing screwing and advancing the needle driver in the correct direction at an increasing angle from the transverse cuff margin with dragging and formation of an adequate loop of thread was used when suturing the vaginal cuff. Using the new vaginal suturing techniques, easy and firm vaginal cuff closure with reduced operative time relative to previous hysterectomies was achieved. The new vaginal cuff suturing techniques may convince more surgeons to perform robotic single-site hysterectomies more frequently and with greater ease. Copyright © 2018. Published by Elsevier B.V.
Kamath, Atul F; Shah, Roshan P; Summers, Nathan; Israelite, Craig L
Extensor mechanism disruption after total knee arthroplasty (TKA) is a complex problem that often requires surgical repair for functional deficits. We present a brief technical note on suture anchor fixation of a patellar tendon rupture after TKA. A surgical technique and literature review follows. Although suture anchor fixation is well described for tendinous repairs in other areas of orthopedic surgery, no study has discussed the use of suture anchors in patellar tendon repair after TKA. The technique must be evaluated in more patients with longer follow-up before adoption. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Pluchino, F; Luccarelli, G
Interfascicular nerve suture with autografts is the operation of choice for repairing peripheral nerve injuries because it ensures more precise alignment of the fasciculi and so better chances of reinnervation of the sectioned nerve. The procedure as described by Millesi et al has been used at the Istituto Neurologico di Milano in 30 patients with traumatic lesions of the median, ulnar and radial nerves. All have been followed up for 2 to 7 years since operation. The results obtained are compared with those of other series obtained with interfascicular suture and with epineural suture. Microsurgery is essential. The best time to operate is discussed.
Reddy, K J; Packer, G J
A case of acute perilunate dislocation associated with acute scapholunate dissociation and acute carpal tunnel syndrome is described in which the treatment was facilitated by the use of the TAG suture anchor.
Kim, Kook-Hyun; Jang, Byung-Ik
The use of non-absorbable suture materials for cystic duct ligation after cholecystectomy can expose patients to the risk of recurrent stone formation in the common bile duct (CBD). However, in Korea suture materials have rarely been found to act as a nidus for common bile duct calculus formation. Recently, we experienced a case in which suture material, that had migrated from a previous cholecystectomy site into the CBD, probably served as a nidus for common bile duct stone formation. The stone was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) and removed successfully using a basket. The authors report a case of surgical suture migration and discuss its subsequent role as a stone forming nucleus within the CBD in a patient who underwent open cholecystectomy; and include a review of the literature. PMID:18309688
Brand, Jefferson C
Barber's biomechanical work is well known to Arthroscopy's readers as thorough, comprehensive, and inclusive of new designs as they become available. In "All-Suture Anchors: Biomechanical Analysis of Pullout Strength, Displacement, and Failure Mode," the latest iteration, Barber and Herbert test all-suture anchors in both porcine femurs and biphasic foam. While we await in vivo clinical trials that compare all-suture anchors to currently used anchors, Barber and Herbert have provided data to inform anchor choice, and using their biomechanical data at time zero from all-suture anchor trials in an animal model, we can determine the anchors' feasibility for human clinical investigations. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Celis, J; Ruiz, E; Berrospi, F; Payet, E
To compare the leakage rate of esophagojejunal anastomosis performed with stapler or hand sutures. We studied a series of 367 patients who underwent total gastrectomy for gastric cancer at the Instituto de Enfermedades Neoplásicas (Lima-Peru) from 1986 to 1999. In 197 patients esophagojejunal anastomosis was performed with stapler and in 170 with manual sutures. There were no differences between both groups with regard to age, TNM stage, operating time and hospital stay. There were 8 anastomotic leakage (4.1%) in the stapler group and 4 (2.4%) in the hand sutures group (p> 0.05). Of these 12 cases, 2 patients (16%) died of causes directly related to the leak of the esophagojejunal anastomosis. There were no statistical differences in the rate of leakage of the esophagojejunal anastomosis performed with stapler or hand sutures, thus both techniques should be accepted as standard procedures.
Grover, Davinder S; Fellman, Ronald L
To describe a novel technique for thermally marking the tip of a suture, in preparation for a gonioscopy-assisted transluminal trabeculotomy. One patient was used as an example for this technique. Technique report. The authors introduce a modification of a novel surgical procedure (GATT) in which a suture is marked and thermally blunted allowing a proper visualization while performing an ab interno, minimally invasive, circumferential 360-degree suture trabeculotomy. The authors have previously reported on the GATT surgery with the use of an illuminated microcatheter, which allowed for visualization of the tip of the catheter as it circumnavigated Schlemm canal. This modification allows for similar visualization of the tip of the suture, however, is much more cost-effective while still maintaining similar safety.
Zhao, Hu; Feng, Jifan; Ho, Thach-Vu; Grimes, Weston; Urata, Mark; Chai, Yang
Bone tissue undergoes constant turnover supported by stem cells. Recent studies showed that perivascular mesenchymal stem cells (MSCs) contribute to the turnover of long bones. Craniofacial bones are flat bones derived from a different embryonic origin than the long bones. The identity and regulating niche for craniofacial bone MSCs remain unknown. Here, we identify Gli1+ cells within the suture mesenchyme as the major MSC population for craniofacial bones. They are not associated with vasculature, give rise to all craniofacial bones in the adult and are activated during injury repair. Gli1+ cells are typical MSCs in vitro. Ablation of Gli1+ cells leads to craniosynostosis and arrest of skull growth, indicating these cells are an indispensible stem cell population. Twist1+/− mice with craniosynostosis show reduced Gli1+ MSCs in sutures, suggesting that craniosynostosis may result from diminished suture stem cells. Our study indicates that craniofacial sutures provide a unique niche for MSCs for craniofacial bone homeostasis and repair. PMID:25799059
Kou, Xiao-Xing; Zhang, Ci; Zhang, Yi-Mei; Cui, Zhen; Wang, Xue-Dong; Liu, Yan; Liu, Da-Wei; Zhou, Yan-Heng
Mechanical tension is widely applied on the suture to modulate the growth of craniofacial bones. Deeply understanding the features of bone formation in expanding sutures could help us to improve the outcomes of clinical treatment and avoid some side effects. Although there are reports that have uncovered some biological characteristics, the regular pattern of sutural bone formation in response to expansion forces is still unknown. Our study was to investigate the shape, arrangement and orientation of new bone formation in expanding sutures and explore related clinical implications. The premaxillary sutures of rat, which histologically resembles the sutures of human beings, became wider progressively under stretch force. Micro-CT detected new bones at day 3. Morphologically, these bones were forming in a finger-like pattern, projecting from the maxillae into the expanded sutures. There were about 4 finger-like bones appearing on the selected micro-CT sections at day 3 and this number increased to about 18 at day 7. The average length of these projections increased from 0.14 mm at day 3 to 0.81 mm at day 7. The volume of these bony protuberances increased to the highest level of 0.12 mm3 at day 7. HE staining demonstrated that these finger-like bones had thick bases connecting with the maxillae and thin fronts stretching into the expanded suture. Nasal sections had a higher frequency of finger-like bones occuring than the oral sections at day 3 and day 5. Masson-stained sections showed stretched fibers embedding into maxillary margins. Osteocalcin-positive osteoblasts changed their shapes from cuboidal to spindle and covered the surfaces of finger-like bones continuously. Alizarin red S and calcein deposited in the inner and outer layers of finger-like bones respectively, which showed that longer and larger bones formed on the nasal side of expanded sutures compared with the oral side. Interestingly, these finger-like bones were almost paralleling with the direction
Manent, Andrea; Lopez, Laia; Vilanova, Joan; Mota, Tiago; Alvarez, Jordi; Santamaría, Alejandro; Oliva, Xavier Martí
Many treatments are available for acute Achilles tendon ruptures, conservative and surgical, with none superior to another. For surgical treatment, one can use various techniques. Recent studies have shown that double stitches are superior to simple sutures. Therefore, in the present study, we sought to determine the suture technique that is the most resistant to rupture. We performed an experimental anatomic study with 27 fresh-frozen human cadaveric Achilles tendons obtained through the body donation program of the University of Barcelona, testing the maximum strength. We simulated a rupture by performing resection in the middle portion of the tendon, 4 cm proximal to the calcaneus insertion. We then evaluated the double Kessler, double Bunnell, Krackow, and percutaneous Ma and Griffith technique. We used absorbable suture (polydioxanone no. 1) with all the techniques. Traction was performed using a machine that pulls the tendon at 10 to 100 N in 1000 repetitive cycles. Statistical analysis was performed using the χ 2 test and analysis of variance, with the 95% confidence intervals (p < .05). All repairs failed at the site of the suture knots, with none pulling out through the substance of the tendon. We found no significant differences among the different open suture techniques (p > .05). The Krackow suture presented with superior resistance, with a rupture rate 16.70% but with a mean elongation of 7.11 mm. The double Bunnell suture had the same rupture rate as the Krakow suture (16.70%) but with an inferior mean elongation of 4.53 mm. The Krackow and Bunnell suture were superior in endurance, strength of failure, and primary stability compared with the other suture types. However, the former presented with greater tendon elongation, although the difference was not statistically significant. Therefore, according to our findings and the published data, we recommend double Bunnell sutures for the surgical treatment of acute Achilles tendon rupture
Lorbach, Olaf; Kieb, Matthias; Raber, Florian; Busch, Lüder C; Kohn, Dieter; Pape, Dietrich
To compare the biomechanical properties and footprint coverage of a single-row (SR) repair using a modified suture configuration versus a double-row (DR) suture-bridge repair in small to medium and medium to large rotator cuff tears. We created 25- and 35-mm artificial defects in the rotator cuff of 24 human cadaveric shoulders. The reconstructions were performed as either an SR repair with triple-loaded suture anchors (2 to 3 anchors) and a modified suture configuration or a modified suture-bridge DR repair (4 to 6 anchors). Reconstructions were cyclically loaded from 10 to 60 N. The load was increased stepwise up to 100, 180, and 250 N. Cyclic displacement and load to failure were determined. Furthermore, footprint widths were quantified. In the 25-mm rupture, ultimate load to failure was 533 ± 107 N for the SR repair and 681 ± 250 N for the DR technique (P ≥ .21). In the 35-mm tear, ultimate load to failure was 792 ± 122 N for the SR reconstruction and 891 ± 174 N for the DR reconstruction (P ≥ .28). There were no statistically significant differences for both tested rupture sizes. Cyclic displacement showed no significant differences between the tested configurations at 60 N (P = .563), 100 N (P = .171), 180 N (P = .211), and 250 N (P = .478) for the 25-mm tear. For the 35-mm tear, cyclic displacement showed significantly lower gap formation for the SR reconstruction at 180 N (P = .037) and 250 N (P = .020). No significant differences were found at 60 N (P = .296) and 100 N (P = .077). A significantly greater footprint width (P = .028) was seen for the DR repair (16.2 mm) compared with the SR repair (13.8 mm). However, both reconstructions were able to achieve complete footprint coverage compared with the initial footprint. The tested SR repair using a modified suture configuration was similar in load to failure and cyclic displacement to the DR suture-bridge technique independent of the tested initial sizes of the rupture. The tested DR repair
Baums, M H; Buchhorn, G H; Spahn, G; Poppendieck, B; Schultz, W; Klinger, H-M
The aim of the study was to evaluate the time zero mechanical properties of single- versus double-row configuration for rotator cuff repair in an animal model with consideration of the stitch technique and suture material. Thirty-two fresh-frozen sheep shoulders were randomly assigned to four repair groups: suture anchor single-row repair coupled with (1) braided, nonabsorbable polyester suture sized USP No. 2 (SRAE) or (2) braided polyblend polyethylene suture sized No. 2 (SRAH). The double-row repair was coupled with (3) USP No. 2 (DRAE) or (4) braided polyblend polyethylene suture No. 2 (DRAH). Arthroscopic Mason-Allen stitches were used (single-row) and combined with medial horizontal mattress stitches (double-row). Shoulders were cyclically loaded from 10 to 180 N. Displacement to gap formation of 5- and 10-mm at the repair site, cycles to failure, and the mode of failure were determined. The ultimate tensile strength was verified in specimens that resisted to 3,000 cycles. DRAE and DRAH had a lower frequency of 5- (P = 0.135) and 10-mm gap formation (P = 0.135). All DRAE and DRAH resisted 3,000 cycles while only three SRAE and one SRAH resisted 3,000 cycles (P < 0.001). The ultimate tensile strength in double-row specimens was significantly higher than in others (P < 0.001). There was no significant variation in using different suture material (P > 0.05). Double-row suture anchor repair with arthroscopic Mason-Allen/medial mattress stitches provides initial strength superior to single-row repair with arthroscopic Mason-Allen stitches under isometric cyclic loading as well as under ultimate loading conditions. Our results support the concept of double-row fixation with arthroscopic Mason-Allen/medial mattress stitches in rotator cuff tears with improvement of initial fixation strength and ultimate tensile load. Use of new polyblend polyethylene suture material seems not to increase the initial biomechanical aspects of the repair construct.
Brown, Christopher A; Hurwit, Daniel; Behn, Anthony; Hunt, Kenneth J
Anatomic repair is indicated for patients who have recurrent lateral ankle instability despite nonoperative measures. There is no difference in repair stiffness, failure torque, or failure angle between specimens repaired with all-soft suture anchors versus the modified Broström-Gould technique with sutures only. Controlled laboratory study. In 10 matched pairs of human cadaveric ankles, the anterior talofibular ligament (ATFL) was incised from its origin on the fibula. After randomization, 1 ankle was repaired to its anatomic insertion using two 1.4-mm JuggerKnot all-soft suture anchors; the other ankle was repaired with a modified Broström-Gould technique using 2-0 FiberWire. All were augmented using the inferior extensor retinaculum. All ankles were mounted to the testing machine in 20° of plantar flexion and 15° of internal rotation and loaded to failure after the repair. Stiffness, failure torque, and failure angle were recorded and compared using a paired Student t test with a significance level set at P < .05. There was no significant difference in failure torque, failure angle, or stiffness. No anchors pulled out of bone. The primary mode of failure was pulling through the ATFL tissue. There was no statistical difference in strength or stiffness between a 1.4-mm all-soft suture anchor and a modified Broström-Gould repair with 2-0 FiberWire. The primary mode of failure was at the tissue level rather than knot failure or anchor pullout. The particular implant choice (suture only, tunnel, anchor) in repairing the lateral ligament complex may not be as important as the time to biological healing. The suture-only construct as described in the Broström-Gould repair was as strong as all-soft suture anchors, and the majority of the ankles failed at the tissue level. For those surgeons whose preference is to use anchor repair, this novel all-soft suture anchor may be an alternative to other larger anchors, as none failed by pullout.
Li, Guang-Tai; Li, Xiao-Fan; Wu, Baoping; Li, Guangrui
To assess the efficacy and safety of longitudinal parallel compression suture to control heavy postpartum hemorrhage (PPH) in patients with placenta previa/accreta. Fifteen women received a longitudinal parallel compression suture to stop life-threatening PPH due to placenta previa with or without accreta during cesarean section. The suture apposed the anterior and posterior walls of the lower uterine segment together using an absorbable thread A 70-mm round needle with a Number-1 absorbable thread was used. The point of needle entry was 1 cm above the upper margin of the cervix and 1 cm from the right lateral border of the lower segment of the anterior wall. The suture was threaded through the uterine cavity to the serosa of the posterior wall. Then, it was directed upward and threaded from the posterior to the anterior wall at ∼1-2 cm above the upper boundary of the lower uterine segment and 3-cm medial to the right margin of the uterus. Both ends of the suture were tied on the anterior aspect of uterus. The left side was sutured in the same way. The success rate of the procedure was 86.7% (13/15). Two of 15 cases were concurrently administered gauze packing and achieved satisfactory hemostasis. All patients resumed a normal menstrual flow, and no postoperative anatomical or physiological abnormalities related to the suture were observed. Three women achieved further pregnancies after the procedure. Longitudinal parallel compression suture is a safe, easy, effective, practical, and conservative surgical technique to stop intractable PPH from the lower uterine segment, particularly in women who have a cesarean scar and placenta previa/accreta. Copyright © 2016. Published by Elsevier B.V.
Kim, Jae-Hwa; Shin, Dong-Eun; Dan, Jin-Myong; Nam, Ki-Shik; Ahn, Tae-Keun; Lee, Dong-Hoon
A root attachment injury (root tear) of the meniscus can abolish the ability of the meniscus to bear hoop stress and predispose to increase articular contact stress which contribute to femorotibial degenerative changes. A pull out suture technique to repair the root tear has been described, but the procedure making the tibial tunnel may be difficult and troublesome. This article describes a repair technique using a suture anchor and posterior trans-septal portal.
Stockley, I.; Elson, R. A.
A disposable skin stapler (Elite: Auto Suture UK Ltd) and Nylon vertical mattress sutures have been used for skin closure. The complications related to each method were evaluated in 129 wounds. There was a higher incidence of inflammation, discomfort on removal and spreading of the healing scar associated with staples. The only advantage of staples was speed of wound closure. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:3566131
Ames, Caroline D; Perrone, Juan M; Frisella, Alison J; Morrissey, Kevin; Landman, Jaime
Various laparoscopic devices have been described for suture anchoring during solidorgan parenchymal closure. Application of these devices expedites the closure of parenchymal defects and minimizes ischemia time. We compared different technologies as suture anchors for parenchymal closure. A tensometer was used to determine the amount of tension necessary to dislodge each of five different clips from Vicryl suture alone or against two different substrates (fresh pig kidney and liver) with and without an intervening pledget. The clips investigated were the Lapra-Ty (Ethicon), Endoclip II (US Surgical), small Horizon Ligating Clips (Weck), Hem-o-lok Medium Polymer Clips (Week), and a novel Suture-clip (Applied Medical). ANOVA and two-sided Fisher's exact test provided statistical analysis. The force required to dislodge the Lapra-Ty clip from bare suture for both 0 and 1 Vicryl (7.0 N) was approximately fourfold the force required to dislodge the Endoclips or the 5-mm or 10-mm Hem-o-lok clips (p<0.01). When clips were applied to suture running through renal or liver parenchyma, the novel Suture-clip required the greatest tension to dislodge (P<0.01), followed by the Horizon and Lapra-Ty clips. There were no statistically significant differences in the tension required to dislodge a given clip from the two parenchymal substrates or in the presence or absence of a pledget. In our experimental model, the Suture-clip, Lapra-Ty, and Horizon clips required significantly greater tension to dislodge than the Hem-o-lok and Endoclip clips. The addition of a pledget did not improve tension resistance.
Gillen, Alex M; Munsterman, Amelia S; Farag, Ramsis; Coleridge, Matthew O D; Hanson, R Reid
To investigate the strength and size of surgeon's and square knots for starting and ending continuous suture lines using large gauge suture. In vitro mechanical study. Knotted suture. Surgeon's and square knots were tested using 2 and 3 USP polyglactin 910 and 2 USP polydioxanone under linear tension on a universal testing machine. Failure mode and knot holding capacity (KHC) were recorded, and relative knot security (RKS) was calculated as a percentage of KHC. Comparisons were made between number of throws, suture size, suture type, and knot types. Knot volume and weight were assessed by a digital micrometer and balance, respectively. There were no significant differences in KHC (P = .295), RKS (P = .307), volume (P = .128), or weight (P = .310) between square and surgeon's knots at the start or end of suture lines with the same number of throws and suture type. A minimum of 6 throws were required for start knots and 7 throws at end knots to prevent unraveling. Knots tied with 3 polyglactin 910 were strongest (P < .001) and 2 polyglactin 910 produced knots with higher KHC and RKS than 2 polydioxanone (P < .001). No consistent differences were detected between knots types tied with the same suture material; however, number of throws affected KHC and RKS up to 6 throws in start or 7 throws in end knots. The configuration of square and surgeon's knots performed at the end of a continuous line alters their KHC, supporting the use of additional throws for knot security. © 2017 The American College of Veterinary Surgeons.
Tompkins, Marc; Monchik, Keith O; Plante, Matthew J; Fleming, Braden C; Fadale, Paul D
To evaluate whether the use of knotless lateral anchors in a suture bridge construct produces better contact area and pressure parameters than a suture bridge construct with standard lateral anchors that require knots or a double-row repair. The hypothesis was that knotless lateral anchors would produce better contact area and pressure parameters than the other two constructs. A total of fifteen matched pairs of cadaveric shoulders were divided into three groups. In Group 1, a suture bridge using knotless anchors for the lateral row was performed on five shoulders. A suture bridge using standard lateral row anchors that require knots was performed on the contralateral shoulders. In Group 2, suture bridge with knotless lateral row anchors was compared with double-row repair. In Group 3, suture bridge using standard lateral row anchors was compared with double-row repair. The contact conditions of the rotator cuff footprint were measured using pressure-sensitive film. There were no statistically significant differences between any of the techniques regarding contact area F(2, 15.7) = 3.09, P = 0.07 or mean contact pressure F(2, 15.1) = 2.35, P = 0.12. A post hoc power analysis suggests differences between techniques are likely less than 91-113 mm(2) for area and 0.071-0.089 N for pressure. The use of knotless anchors in the lateral row of a suture bridge repair did not increase the footprint contact area or contact pressure when compared to a suture bridge repair requiring knots laterally or to a double-row repair.
McLaughlin, Jillian M.; Ross, Lindy S.; Phillips, Linda G.; Wagner, Richard F.
Summary: Scalp defects greater than 2 cm in diameter are not usually amenable to primary closure and require local tissue rearrangement, grafting, tissue expansion, or prolonged second intention healing. Scalp flap reconstruction is a significant undertaking that requires elevation of a total flap surface area that is 3–6 times the size of the defect, often involves profuse bleeding, and can be challenging to perform without conscious sedation or general anesthesia. Anticoagulated and medically complex patients pose additional challenges and limit options for treatment. The pulley suture uses the mechanical advantage of the pulley to distribute tension across a wound and is useful in areas of high tension such as scalp wounds. For scalp wounds greater than 2 cm, pulley sutures are placed along the length of the wound. An assistant exerts equal tension on the pulley sutures, and the surgeon sequentially ties the sutures. The sutures are tightened and retied weekly until complete scalp closure is achieved. The pulley sutures can be used for rapid primary closure of scalp wounds up to 2.5–3.0 cm in diameter under local anesthesia. For scalp wounds larger than 3 cm, we have also found that pulley sutures can be progressively tightened yielding additional tissue expansion every week. Scalp wounds greater than 3.0 cm can be easily closed via primary repair and weekly tightening of pulley sutures without the need for flap reconstruction, traditional tissue expander placement, or second intention healing. PMID:29632771
Geiger, Madeleine; Haussman, Sinah
Bulldog-type brachycephalic domestic dog breeds are characterized by a relatively short and broad skull with a dorsally rotated rostrum (airorhynchy). Not much is known about the association between a bulldog-type skull conformation and peculiar patterns of suture and synchondrosis closure in domestic dogs. In this study, we aim to explore breed-specific patterns of cranial suture and synchondrosis closure in relation to the prebasial angle (proxy for airorhynchy and thus bulldog-type skull conformation) in domestic dogs. For this purpose, we coded closure of 18 sutures and synchondroses in 26 wolves, that is, the wild ancestor of all domestic dogs, and 134 domestic dogs comprising 11 breeds. Comparisons of the relative amount of closing and closed sutures and synchondroses (closure scores) in adult individuals showed that bulldog-type breeds have significantly higher closure scores than non-bulldog-type breeds and that domestic dogs have significantly higher closure scores than the wolf. We further found that the prebasial angle is significantly positively correlated with the amount of closure of the basispheno-presphenoid synchondrosis and sutures of the nose (premaxillo-nasal and maxillo-nasal) and the palate (premaxillo-maxillary and interpalatine). Our results show that there is a correlation between patterns of suture and synchondrosis closure and skull shape in domestic dogs, although the causal relationships remain elusive. © 2016 Wiley Periodicals, Inc.
Malik, I. A.; Mirkhalaf, M.; Barthelat, F.
Structural biological materials such as bone, teeth or mollusk shells draw their remarkable performance from a sophisticated interplay of architectures and weak interfaces. Pushed to the extreme, this concept leads to sutured materials, which contain thin lines with complex geometries. Sutured materials are prominent in nature, and have recently served as bioinspiration for toughened ceramics and glasses. Sutures can generate large deformations, toughness and damping in otherwise all brittle systems and materials. In this study we examine the design and optimization of sutures with a jigsaw puzzle-like geometry, focusing on the non-linear traction behavior generated by the frictional pullout of the jigsaw tabs. We present analytical models which accurately predict the entire pullout response. Pullout strength and energy absorption increase with higher interlocking angles and for higher coefficients of friction, but the associated high stresses in the solid may fracture the tabs. Systematic optimization reveals a counter-intuitive result: the best pullout performance is achieved with interfaces with low coefficient of friction and high interlocking angle. We finally use 3D printing and mechanical testing to verify the accuracy of the models and of the optimization. The models and guidelines we present here can be extended to other types of geometries and sutured materials subjected to other loading/boundary conditions. The nonlinear responses of sutures are particularly attractive to augment the properties and functionalities of inherently brittle materials such as ceramics and glasses.
Kathju, Sandeep; Nistico, Laura; Tower, Irene; Lasko, Leslie-Ann; Stoodley, Paul
Surgical site infection (SSI) has been estimated to occur in up to 5% of all procedures, accounting for up to 0.5% of all hospital costs. Bacterial biofilms residing on implanted foreign bodies have been implicated as contributing or causative factors in a wide variety of infectious scenarios, but little consideration has been given to the potential for implanted, submerged suture material to act as a host for biofilm and thus serve as a nidus of infection. We report a series of 15 patients who underwent open Roux-en-Y gastric bypass (with musculofascial closure with permanent, multifilament sutures) who developed longstanding and refractory SSIs in the abdominal wall. Explanted suture material at subsequent exploration was examined for biofilm with confocal laser-scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH). All 15 patients at re-exploration were found to have gross evidence of a "slimy" matrix or dense reactive granulation tissue localized to the implanted sutures. Confocal laser-scanning microscopy revealed abundant biofilm present on all sutures examined; FISH was able to identify the presence of specific pathogens in the biofilm. Complete removal of the foreign bodies (and attendant biofilms) resulted in all cases in cure of the SSI. Bacterial biofilms on implanted suture material can manifest as persistent surgical site infections that require complete removal of the underlying foreign body substrata for resolution.
Takeoka, Tomohira; Takiguchi, Shuji; Uemura, Munenori; Miyazaki, Yasuhiro; Takahashi, Tsuyoshi; Kurokawa, Yukinori; Makino, Tomoki; Yamasaki, Makoto; Mori, Masaki; Yuichiro Doki, And
The skills necessary for performing effective laparoscopic suturing are difficult to acquire; as a result, simulators for learning these skills are rapidly becoming integrated into surgical training. The aim of the study was to verify whether a new hybrid simulator has the potential to measure skill improvement in young, less experienced gastroenterological surgeons. The study included 12 surgeons (median age, 29 (27-38)] years; 11 men (91.7%), one woman (8.3%)) who participated in a two-day laparoscopic training seminar. We used the new simulator before and after the program to evaluate individual performance. Skills were evaluated using five criteria: volume of air pressure leakage, number of full-thickness sutures, suture tension, wound area, and performance time. Air pressure leakage was significantly higher after than before the training (p = .027). The number of full-thickness sutures was significantly higher post-training (p < .01). Suture tension was significantly less post-training (p = .011). Wound opening areas were significantly smaller post-training (p = .018). Performance time was significantly shorter post-training (p = .032). Our study demonstrated the assessment quality of this new laparoscopic suture simulator.
Adam, Ahmed; Sookram, Jayveer
Background To describe a novel bladder fixation technique for use during endoscopic vesicostomy button insertion. Methods After standard cystoscopic visualization of the bladder, a standard 18 G intravenous cannula was inserted into the bladder. A non-absorbable suture thread was placed through this intravenous cannula under cystoscopic vision. The proximal end of the suture was then removed using standard ureteroscopic grasping forceps (3 Fr) through another needle (15 G) inserted next to the initial puncture site (following a path at 30 degrees from the initial puncture tract) into the bladder. The suture ends were brought out of the bladder and tied at the skin level, 2 cm from the intended vesicostomy site. Sutures were removed on the second postoperative day. Results This fixation technique allows for adequate fixation of the bladder dome to the anterior abdominal wall. These sutures also have less potential for cutaneous scarring and pain. No complications were reported. Conclusion This simple fixation technique is easily performed using materials found in every urology suite. It also avoids the skills required with other previously reported fixation suture techniques, and can also be utilized for bladder fixation in cases of vesicoscopic laparoscopic or robotic assisted laparoscopic procedures. PMID:29692696
Rieder, E; Asari, R; Paireder, M; Lenglinger, J; Schoppmann, S F
The aim of this study is to compare endoscopic stent suture fixation with endoscopic clip attachment or the use of partially covered stents (PCS) regarding their capability to prevent stent migration during prolonged dilatation in achalasia. Large-diameter self-expanding metal stents (30 mm × 80 mm) were placed across the gastroesophageal junction in 11 patients with achalasia. Stent removal was scheduled after 4 to 7 days. To prevent stent dislocation, endoscopic clip attachment, endoscopic stent suture fixation, or PCS were used. The Eckardt score was evaluated before and 6 months after prolonged dilatation. After endoscopic stent suture fixation, no (0/4) sutured stent migrated. When endoscopic clips were used, 80% (4/5) clipped stents migrated (p = 0.02). Of two PCS (n = 2), one migrated and one became embedded leading to difficult stent removal. Technical adverse events were not seen in endoscopic stent suture fixation but were significantly correlated with the use of clips or PCS (r = 0.828, p = 0.02). Overall, 72% of patients were in remission regarding their achalasia symptoms 6 months after prolonged dilatation. Endoscopic suture fixation of esophageal stents but not clip attachment appears to be the best method of preventing early migration of esophageal stents placed at difficult locations such as at the naive gastroesophageal junction. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: email@example.com.
Kitamura, Riley K; Choi, Jacqueline; Lynn, Elizabeth; Divino, Celia M
Mesh fixation in laparoscopic umbilical hernia repair is poorly studied. We compared postoperative outcomes of laparoscopic umbilical hernia repair in suture versus tack mesh fixation. Patients who underwent laparoscopic umbilical hernia repair were separated by method of mesh fixation: sutures versus primarily tacks. Medical history and follow-up data were collected through medical records. The primary outcome of this study was the recurrence rates of hernias. Postoperative major and minor complications, such as surgical site infection, small-bowel obstruction, and seroma formation, were regarded as secondary outcomes. Additionally, a telephone interview was conducted to assess postoperative pain, recovery time, and overall patient satisfaction. Eighty-six patients were identified: 33 in the suture group and 53 in the tacks group. The number of emergent cases was increased in the tacks group (6 vs 0; P = .022). Mean follow-up time was 2.7 years for both groups. Documented postoperative follow-up was obtained in 29 (90%) suture group and 31 (58%) tacks group patients. Hernia recurrence occurred in 3 and 2 patients in the sutures and tacks groups, respectively (P was not significant). No differences were found in secondary outcomes, including subjective outcomes from telephone interviews, between groups. There are no differences in postoperative complication rates in suture versus tack mesh fixation in laparoscopic umbilical hernia repair.
Verwilghen, D; Busoni, V; van Galen, G; Wilke, M
Instructions on how to debone and stuff a turkey are available, but what is the best way to close it up? A randomised trial involving 15 turkeys was performed in order to evaluate skin disruption scores and cosmetic outcomes following the use of different suture patterns. Turkeys were deboned, stuffed and cooked according to guidelines of the US Department of Agriculture Food Safety and Inspection Services. After stuffing, they were randomly assigned to one of five closure groups: simple continuous Lembert; simple continuous Cushing; simple continuous Utrecht; simple continuous; or staples. Turkeys were cooked at 180 °C for two hours ensuring core temperature reached 75 °C. Suture line integrity was evaluated after removal of the sutures and the cosmetic aspect was graded. Before cooking, the Utrecht pattern and skin staples offered the best cosmetic result. After removal of the sutures, the skin remained intact only in the stapled group. All other suture patterns disrupted the skin after removal of the sutures, rendering the turkey less cosmetically appealing for serving. Closure of a stuffed turkey was best performed using skin staples to achieve the best cosmetic results. Using this technique you will be able to impress family and friends at a Christmas dinner, and finally show them your surgical skills.
Stefanidis, Dimitrios; Hope, William W; Scott, Daniel J
The value of robotic assistance for intracorporeal suturing is not well defined. We compared robotic suturing with laparoscopic suturing on the FLS model with a large cohort of surgeons. Attendees (n=117) at the SAGES 2006 Learning Center robotic station placed intracorporeal sutures on the FLS box-trainer model using conventional laparoscopic instruments and the da Vinci® robot. Participant performance was recorded using a validated objective scoring system, and a questionnaire regarding demographics, task workload, and suturing modality preference was completed. Construct validity for both tasks was assessed by comparing the performance scores of subjects with various levels of experience. A validated questionnaire was used for workload measurement. Of the participants, 84% had prior laparoscopic and 10% prior robotic suturing experience. Within the allotted time, 83% of participants completed the suturing task laparoscopically and 72% with the robot. Construct validity was demonstrated for both simulated tasks according to the participants' advanced laparoscopic experience, laparoscopic suturing experience, and self-reported laparoscopic suturing ability (p<0.001 for all) and according to prior robotic experience, robotic suturing experience, and self-reported robotic suturing ability (p<0.001 for all), respectively. While participants achieved higher suturing scores with standard laparoscopy compared with the robot (84±75 vs. 56±63, respectively; p<0.001), they found the laparoscopic task more physically demanding (NASA score 13±5 vs. 10±5, respectively; p<0.001) and favored the robot as their method of choice for intracorporeal suturing (62 vs. 38%, respectively; p<0.01). Construct validity was demonstrated for robotic suturing on the FLS model. Suturing scores were higher using standard laparoscopy likely as a result of the participants' greater experience with laparoscopic suturing versus robotic suturing. Robotic assistance decreases the physical
Priester, Carolina; Dillaman, Richard M.; Gay, D. Mark
The ecdysial suture is the region of the arthropod exoskeleton that splits to allow the animal to emerge during ecdysis. We examined the morphology and composition of the intermolt and premolt suture of the blue crab using light microscopy and scanning electron microscopy. The suture could not be identified by routine histological techniques; however 3 of 22 fluorescein isothiocyanate-labeled lectins tested (Lens culinaris agglutinin, Vicia faba agglutinin, and Pisum sativum agglutinin) differentiated the suture, binding more intensely to the suture exocuticle and less intensely to the suture endocuticle. Back-scattered electron (BSE) and secondary electron observations of fracture surfaces of intermolt cuticle showed less mineralized regions in the wedge-shaped suture as did BSE analysis of premolt and intermolt resin-embedded cuticle. The prism regions of the suture exocuticle were not calcified. X-ray microanalysis of both the endocuticle and exocuticle demonstrated that the suture was less calcified than the surrounding cuticle with significantly lower magnesium and phosphorus concentrations, potentially making its mineral more soluble. The presence or absence of a glycoprotein in the organic matrix, the extent and composition of the mineral deposited, and the thickness of the cuticle all likely contribute to the suture being removed by molting fluid, thereby ensuring successful ecdysis.
Boyd, James W.; Deters, Katherine A.; Brown, Richard S.
Reductions in the size of acoustic transmitters implanted in migrating juvenile salmonids have resulted in the use of a shorter incision-one that may warrant only a single suture for closure. However, it is not known whether a single suture will sufficiently hold the incision closed when fish are decompressed and when outward pressure is placed on the surgical site during turbine passage through hydroelectric dams. The objective of this study was to evaluate the effectiveness of single-suture incision closures on five response variables in juvenile Chinook salmon Oncorhynchus tshawytscha that were subjected to simulated turbine passage. An acoustic transmitter (0.43more » g in air) and a passive integrated transponder tag (0.10 g in air) were implanted in each fish; the 6-mm incisions were closed with either one suture or two sutures. After exposure to simulated turbine passage, none of the fish exhibited expulsion of transmitters. In addition, the percentage of fish with suture tearing, incision tearing, or mortal injury did not differ between treatments. Expulsion of viscera through the incision was higher among fish that received one suture (12%) than among fish that received two sutures (1%). The higher incidence of visceral expulsion through single-suture incisions warrants concern. Consequently, for cases in which tagged juvenile salmonidsmay be exposed to turbine passage, we do not recommend the use of one suture to close 6-mm incisions associated with acoustic transmitter implantation.« less
Deters, Katherine A.; Brown, Richard S.; Carter, Kathleen M.
This study assessed performance of seven suture types in subyearling Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Nonabsorbable (Ethilon) and absorbable (Monocryl) monofilament and nonabsorbable (Nurolon, silk) and absorbable (Vicryl, Vicryl Plus, Vicryl Rapide) braided sutures were used to close incisions in Chinook salmon. Monocryl exhibited greater suture retention than all other suture types 7 d after surgery. Both monofilament suture types were retained better than all braided suture types at 14 d. Incision openness and tag retention did not differ among suture types. Wound inflammation was similar for Ethilon, Monocryl, and Nurolon at 7 d. Wound ulceration wasmore » lower for Ethilon, Monocryl, and Nurolon than for all other suture types at 14 d post-surgery. Fish held in 12°C water had more desirable post-surgery healing characteristics (i.e., higher suture and tag retention and lower incision openness, wound inflammation, and ulceration) at 7 and 14 d after surgery than those held in 17°C water. The effect of surgeon was a significant predictor for all response variables at 7 d. This result emphasizes the importance of including surgeon as a variable in telemetry study analyses when multiple surgeons are used. Monocryl performed better with regard to post-surgery healing characteristics in the study fish. The overall results support the conclusion that Monocryl is the best suture material to close incisions created during surgical implantation of acoustic microtransmitters in subyearling Chinook salmon.« less
Lambertz, Andreas; Schröder, Kai Michael; Schöb, Dominik Stefan; Binnebösel, Marcel; Anurov, Michael; Klinge, Uwe; Neumann, Ulf Peter; Klink, Christian Daniel
Biocompatibility and tissue integration of a surgical suture are decisive factors for wound healing and therefore for the success of sutures. The optimal suture material is still under discussion. Polyvinylidene fluoride (PVDF) is described to have superior properties of biocompatibility and is therefore frequently used as a mesh component. Only little information is available about its use as a suture material. The aim of this study was to evaluate the biocompatibility of PVDF as a suture material in comparison to 5 different established sutures in a rat model. In 30 male rats, a monofilamental PVDF suture (Resopren®) and 5 established control suture materials [polyester (Miralene®), polytetrafluoroethylene (Gore®), poliglecaprone (Monocryl®), polydioxanone (Monoplus®), polyglactin 910 (Vicryl®), USP size 3-0] were placed in the subcutaneous layer of the abdominal wall without knot or tension. After 3, 7 or 21 days, the abdominal walls were explanted for histopathological and immunohistochemical investigation with special regard to the size and quality of foreign body granuloma and the length of the comet tail-like infiltrate (CTI). The PVDF sutures showed the smallest size of foreign body granuloma (60 ± 14 µm) and the smallest CTI length (343 ± 60 µm) of all polymers after 21 days. Only PVDF (Resopren) and polydioxanone (Monoplus) showed a significant collagen I/III ratio increase between days 3 and 21 (p = 0.009 and p = 0.016). The quality of foreign body reaction regarding inflammation, proliferation and fibrotic remodeling was similar between all suture materials. Our data indicate that monofilamental PVDF sutures show a favorable foreign body reaction with small granuloma sizes and CTI length in comparison to established sutures. Its use as a suture material in general surgery could therefore be extended in the future. To reinforce these findings, further clinical studies need to be conducted. 2015 S. Karger AG, Basel.
Su, Chien-Min; Wen, Strong; Tang, Chi-Chia; Yeh, Yu-Lien; Chen, Chau-Huei
Northern Vietnam is divided into two regions by suture zone. The southwestern region belongs to the Indochina block, and the northeastern region is a portion of the South China block with distinct geological characteristics. From previous studies, the closing the Paleotethys led the collision between the Indochina and South China blocks, and this collision form the suture zone in the Middle Triassic. In the Tertiary, Indian and Eurasian plates started to collide, and this collision caused the extrusion of the Indochina block along the suture zone and a clockwise rotation. Metamorphic rocks associated with the subduction process have been found at the Song Ma Shear Zone (SMSZ) from geological surveys, which indicated that the SMSZ is a possible boundary between the South China and Indochina block. However, according to previous study, there is an argument of whether the SMSZ is a subduction zone of the South China and Indochina plates or not. In this study, we applied the H-κ and the common conversion point (CCP) stacking method using teleseismic converted waves recorded by a seismic broadband array to obtain the Moho depth, VP/VS ratio and the crustal structure along the SMSZ. The CCP results are further used to identify whether the fault extends through the entire crust or not. We have selected two profiles along the SMSZ and a profile across the SMSZ for imaging lateral variations of impedance from stacking. According to H-κ stacking results, crustal thickness vary from 26.0 to 29.3 km, and the average of VP/VS ratio is about 1.77. Finally, the CCP results also show the heterogeneity of crust among the SMSZ. These evidences might support that SMSZ is the suture zone between the South China and Indochina plates.
Hembree, W Chad; Tsai, Michael A; Parks, Brent G; Miller, Stuart D
We compared the pullout strength of a suture-based anchor versus a bioabsorbable anchor in the distal fibula and calcaneus and evaluated the relationship between bone mineral density and peak load to failure. Eight paired cadaveric specimens underwent a modified Broström procedure and Achilles tendon reattachment. The fibula and calcaneus in the paired specimens received either a suture-based anchor or a bioabsorbable suture anchor. The fibular and calcaneal specimens were loaded to failure, defined as a substantial decrease in the applied load or pullout from the bone. In the fibula, the peak load to failure was significantly greater with the suture-based versus the bioabsorbable anchors (133.3 ± 41.8 N versus 76.8 ± 35.3 N; p = .002). No significant difference in load with 5 mm of displacement was found between the 2 groups. In the calcaneus, no difference in the peak load to failure was found between the 2 groups, and the peak load to failure with 5 mm of displacement was significantly lower with the suture-based than with the bioabsorbable anchors (52.2 ± 9.8 N versus 75.9 ± 12.4 N; p = .003). Bone mineral density and peak load to failure were significantly correlated in the fibula with the suture-based anchor. An innovative suture-based anchor had a greater peak load to failure compared with a bioabsorbable anchor in the fibula. In the calcaneus, the load at 5 mm of displacement was significantly lower in the suture-based than in the bioabsorbable group. The correlation findings might indicate the need for a cortical bone shelf with the suture-based anchor. Suture-based anchors could be a viable alternative to bioabsorbable anchors for certain foot and ankle procedures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
Law, Andy Y; Butler, James R; Patnaik, Sourav S; Cooley, James A; Elder, Steven H
To compare the biomechanical strength and histologic features of 3-0 Glycomer™ 631 barbed suture (V-LOC™ 90 Absorbable Wound Closure Device, Covidien, Mansfield, MA) to non-barbed 3-0 Glycomer™ 631 suture (Biosyn™, Covidien) for intradermal skin wound closure in the dog. Randomized, factorial, in vivo. Eighteen purpose-bred, mature male, and female hound dogs. Eighteen adult hound dogs were randomly assigned to 1 of 3 groups designated by postoperative day of assessment. Six skin incisions were made along the dorsum in the thoracolumbar region of each dog with an equal number (n=3) randomly assigned to closure with barbed or non-barbed suture. Six dogs were euthanatized on postoperative days 3, 10, and 14, respectively. Two additional incisions were made on each dog after euthanasia for baseline data (Day 0). The skin incision specimens were harvested for biomechanical testing and histologic evaluation. Non-barbed closure had significantly higher maximum load at failure (P<.001) and stiffness (P<.001) than barbed closure regardless of day. The average tissue reaction score was significantly higher for barbed closure (P=.008), regardless of day. Suturing time for barbed closures was significantly shorter. There was no significant difference in frequency of complications between closures. Barbed Glycomer™ 631 closures had a significantly lower maximum load at failure and stiffness, and higher average tissue reaction scores, but showed no difference in short term outcome for intradermal closure of dorsally located skin incisions in dogs. © 2016 The American College of Veterinary Surgeons.
Romanyk, D L; Liu, S S; Lipsett, M G; Toogood, R W; Lagravère, M O; Major, P W; Carey, J P
Maxillary expansion treatment is a commonly used procedure by orthodontists to widen a patient's upper jaw. As this is typically performed in adolescent patients, the midpalatal suture, connective tissue adjoining the two maxilla halves, remains unfused. Studies that have investigated patient response to expansion treatment, generally through finite element analysis, have considered this suture to behave in a linear elastic manner or it was left vacant. The purpose of the study presented here was to develop a model that could represent the midpalatal suture's viscoelastic behavior. Quasilinear viscoelastic, modified superposition, Schapery's, and Burgers modeling approaches were all considered. Raw data from a previously published study using New Zealand White Rabbits was utilized for model parameter estimation and validation. In this study, Sentalloy(®) coil springs at load levels of 0.49N (50g), 0.98N (100g), and 1.96N (200g) were used to widen the midsagittal suture of live rabbits over a period of 6 weeks. Evaluation was based on a models ability to represent experimental data well over all three load sets. Ideally, a single set of model constants could be used to represent data over all loads tested. Upon completion of the analysis it was found that the modified superposition method was able to replicate experimental data within one standard deviation of the means using a single set of constants for all loads. Future work should focus on model improvement as well as prediction of treatment outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.
Cho, Byung-Ki; Kim, Yong-Min; Kim, Dong-Soo; Choi, Eui-Sung; Shon, Hyun-Chul; Park, Kyoung-Jin
The present prospective, randomized study was conducted to compare the clinical outcomes of the modified Brostrom procedure using single and double suture anchors for chronic lateral ankle instability. A total of 50 patients were followed up for more than 2 years after undergoing the modified Brostrom procedure. Of the 50 procedures, 25 each were performed using single and double suture anchors by 1 surgeon. The Karlsson scale had improved significantly to 89.8 points and 90.6 points in the single and double anchor groups, respectively. Using the Sefton grading system, 23 cases (92%) in the single anchor group and 22 (88%) in the double anchor group achieved satisfactory results. The talar tilt angle and anterior talar translation on stress radiographs using the Telos device had improved significantly to an average of 5.7° and 4.6 mm in the single anchor group and 4.5° and 4.3 mm in the double anchor group, respectively. The double anchor technique was superior with respect to the postoperative talar tilt. The single and double suture anchor techniques produced similar clinical and functional outcomes, with the exception of talar tilt as a reference of mechanical stability. The modified Brostrom procedure using both single and double suture anchors appears to be an effective treatment method for chronic lateral ankle instability. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
Virk, Mandeep S; Bruce, Benjamin; Hussey, Kristen E; Thomas, Jacqueline M; Luthringer, Tyler A; Shewman, Elizabeth F; Wang, Vincent M; Verma, Nikhil N; Romeo, Anthony A; Cole, Brian J
To compare the biomechanical performance of medial row suture placement relative to the musculotendinous junction (MTJ) in a cadaveric transosseous equivalent suture bridge (TOE-SB) double-row (DR) rotator cuff repair (RCR) model. A TOE-SB DR technique was used to reattach experimentally created supraspinatus tendon tears in 9 pairs of human cadaveric shoulders. The medial row sutures were passed either near the MTJ (MTJ group) or 10 mm lateral to the MTJ (rotator cuff tendon [RCT] group). After the supraspinatus repair, the specimens underwent cyclic loading and load to failure tests. The localized displacement of the markers affixed to the tendon surface was measured with an optical tracking system. The MTJ group showed a significantly higher (P = .03) medial row failure (5/9; 3 during cyclic testing and 2 during load to failure testing) compared with the RCT group (0/9). The mean number of cycles completed during cyclic testing was lower in the MTJ group (77) compared with the RCT group (100; P = .07) because 3 specimens failed in the MTJ group during cyclic loading. There were no significant differences between the 2 study groups with respect to biomechanical properties during the load to failure testing. In a cadaveric TOE-SB DR RCR model, medial row sutures through the MTJ results in a significantly higher rate of medial row failure. In rotator cuff tears with tendon tissue loss, passage of medial row sutures through the MTJ should be avoided in a TOE-SB RCR technique because of the risk of medial row failure. Copyright © 2016. Published by Elsevier Inc.
The widespread application of the B-Lynch brace suture to control postpartum hemorrhage has sparked interest in a variety of adjunctive methods, used alone or in combination, to control uterine bleeding. Although the B-Lynch brace suture has been used with good results throughout the world, failures can and do occur in rare instances, especially when the suture is incorrectly placed for use for an inappropriate indication. Four reports of additional methods to control postpartum hemorrhage are published in this issue of IJGO. Three use the B-Lynch brace suture combined with other techniques. The need for additional techniques reminds the reader of the importance of proper suture application for proper indication. Potential reasons for failure of the B-Lynch suture are provided.
Ram, Jagat; Gupta, Nishant; Chaudhary, Manish; Verma, Neelam
Background: A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture. Materials: We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child. Results: We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up. Conclusions: Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens. PMID:23619504
White, Jeremy B; Barraja, Mathieu; Mengesha, Tewodros; Bose, Sumit; Ashktorab, Samaneh; Bahn, Ryan; Vallance, Ryan; Lindsey, William H
Manipulation and suspension of the superficial musculoaponeurotic system (SMAS) is performed by 74% of rhytidectomy surgeons. Multiple variations in suture techniques are employed in this task, but they have never been evaluated for differences in their ability to withstand stress. To compare the biomechanical properties of two different suture techniques that are used in SMAS plications during rhytidectomy: a double-layered running locking (DRL) stitch and multiple horizontal mattress stitches. Fourteen horizontal mattress plications, in rows of six sutures, and comparable lengths of 16 DRL stitch plications of pig skin samples, were stressed using a tensometer with grip displacement increasing at a constant rate of 0.5 cm/Min. The required force to cause plication failure was recorded for each sample at three suture break points. There was no significant difference between the two groups in the force required to cause the initial suture failure. Unlike the horizontal mattress plication, an initial break seemed to cause minimal to no distortion of the DRL tissue plication. When results were normalized by the initial break forces to account for small variations in tissue properties, the force ratio required to cause a second suture break was significantly larger in the DRL group than in the horizontal mattress technique. This is evidenced by the average second to first break force ratios of 1.62 vs. 1.13 for the DRL and horizontal mattress stitches, respectively, with a P-value of .60. The mean ratios of third to first break forces for the DRL and horizontal mattress groups were 2.08 and 0.91, respectively, with a P-value of .08. The DRL stitch requires more force than the horizontal mattress stitch to cause significant failure of tissue plication. This technique may enable plastic surgeons to avoid early revision rhytidectomy due to suture failure, and to create a long-lasting, youthful cosmetic result.
Bueno, Letícia Rossi; Binda, Marcia; Monego, Heleusa; Scherer, Roberta Luísa; Rolim, Karen Machado; Bottini, Alessandra Leal; Fregnani, José H T G; dos Reis, Ricardo
Compare blood loss during cold knife conization of the cervix with and without lateral hemostatic sutures in the cervical branches of the uterine arteries. Randomized clinical trial. Hospital de Clínicas de Porto Alegre (HCPA). 102 patients that underwent cold knife conization. Women that underwent cold knife conization of the cervix were randomized to undergo the procedure with or without lateral hemostatic sutures. blood loss measured in grams. operative time and postoperative intervention. Only the participants were blinded to group assignment. From March 2009 to August 2012, patients were randomly assigned to one of the study groups. There were no differences in amount of blood loss between patients that underwent the procedure with and without sutures (p = 0.39). Operative time was shorter in the group without suture (p = 0.020). There were no differences in intervention due to bleeding (p = 0.20). Blood loss was greater among menstruating women than for menopausal women (p = 0.011). There were no differences in amount of blood lost between smoking and nonsmoking patients (p = 0.082). Lateral hemostatic sutures do not affect the amount of intraoperative bleeding or the number of postoperative interventions. Their use is not necessary because they result in longer operative time, have a higher cost due to the use of suture material and pose the risk of ureter lesion in case the sutures are not placed at a lower position in the cervix. ClinicalTrials. gov identifier: NCT02184975. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.
Black, Laurel; Bennfors, Grace; Parsons, Trish E.; Elsalanty, Mohammed E.; Yu, Jack C.; Weinberg, Seth M.; Cray, James J.
Large scale surveillance studies, case studies, as well as cohort studies have identified the influence of thyroid hormones on calvarial growth and development. Surveillance data suggests maternal thyroid disorders (hyperthyroidism, hypothyroidism with pharmacological replacement, and Maternal Graves Disease) are linked to as much as a 2.5 fold increased risk for craniosynostosis. Craniosynostosis is the premature fusion of one or more calvarial growth sites (sutures) prior to the completion of brain expansion. Thyroid hormones maintain proper bone mineral densities by interacting with growth hormone and aiding in the regulation of insulin like growth factors (IGFs). Disruption of this hormonal control of bone physiology may lead to altered bone dynamics thereby increasing the risk for craniosynostosis. In order to elucidate the effect of exogenous thyroxine exposure on cranial suture growth and morphology, wild type C57BL6 mouse litters were exposed to thyroxine in utero (control = no treatment; low ~167 ng per day; high ~667 ng per day). Thyroxine exposed mice demonstrated craniofacial dysmorphology (brachycranic). High dose exposed mice showed diminished area of the coronal and widening of the sagittal sutures indicative of premature fusion and compensatory growth. Presence of thyroid receptors was confirmed for the murine cranial suture and markers of proliferation and osteogenesis were increased in sutures from exposed mice. Increased Htra1 and Igf1 gene expression were found in sutures from high dose exposed individuals. Pathways related to the HTRA1/IGF axis, specifically Akt and Wnt, demonstrated evidence of increased activity. Overall our data suggest that maternal exogenous thyroxine exposure can drive calvarial growth alterations and altered suture morphology. PMID:27959899
Wagner, Emilio; Ortiz, Cristian; Wagner, Pablo; Guzman, Rodrigo; Ahumada, Ximena; Maffulli, Nicola
Side-to-side tenorrhaphy is increasingly used, but its mechanical performance has not been studied. Two porcine flexor digitorum tendon segments of equal length (8 cm) and thickness (1 cm) were placed side by side. Eight tenorrhaphies (involving sixteen tendons) were performed with each of four suture techniques (running locked, simple eight, vertical mattress, and pulley suture). The resulting constructs underwent cyclic loading on a tensile testing machine, followed by monotonically increasing tensile load if failure during cyclic loading did not occur. Clamps secured the tendons on each side of the repair, and specimens were mounted vertically. Cyclic loading varied between 15 N and 35 N, with a distension rate of 1 mm/sec. Cyclic loading strength was determined by applying a force of 70 N. The cause of failure and tendon distension during loading were recorded. All failures occurred in the monotonic loading phase and resulted from tendon stripping. No suture or knot failure was observed. The mean loads resisted by the configurations ranged from 138 to 398 N. The mean load to failure, maximum load resisted prior to 1 cm of distension, and load resisted at 1 cm of distension were significantly lower for the vertical mattress suture group than for any of the other three groups (p < 0.031). All four groups sustained loads well above the physiologic loads expected to occur in tendons in the foot and ankle (e.g., in tendon transfer for tibialis posterior tendon insufficiency). None of the four side-to-side configurations distended appreciably during the cyclic loading phase. The vertical mattress suture configuration appeared to be weaker than the other configurations. For surgeons who advocate immediate loading or motion of a side-to-side tendon repair, a pulley, running locked, or simple eight suture technique appears to provide a larger safety margin compared with a vertical mattress suture technique.
Howie, R Nicole; Durham, Emily L; Black, Laurel; Bennfors, Grace; Parsons, Trish E; Elsalanty, Mohammed E; Yu, Jack C; Weinberg, Seth M; Cray, James J
Large scale surveillance studies, case studies, as well as cohort studies have identified the influence of thyroid hormones on calvarial growth and development. Surveillance data suggests maternal thyroid disorders (hyperthyroidism, hypothyroidism with pharmacological replacement, and Maternal Graves Disease) are linked to as much as a 2.5 fold increased risk for craniosynostosis. Craniosynostosis is the premature fusion of one or more calvarial growth sites (sutures) prior to the completion of brain expansion. Thyroid hormones maintain proper bone mineral densities by interacting with growth hormone and aiding in the regulation of insulin like growth factors (IGFs). Disruption of this hormonal control of bone physiology may lead to altered bone dynamics thereby increasing the risk for craniosynostosis. In order to elucidate the effect of exogenous thyroxine exposure on cranial suture growth and morphology, wild type C57BL6 mouse litters were exposed to thyroxine in utero (control = no treatment; low ~167 ng per day; high ~667 ng per day). Thyroxine exposed mice demonstrated craniofacial dysmorphology (brachycranic). High dose exposed mice showed diminished area of the coronal and widening of the sagittal sutures indicative of premature fusion and compensatory growth. Presence of thyroid receptors was confirmed for the murine cranial suture and markers of proliferation and osteogenesis were increased in sutures from exposed mice. Increased Htra1 and Igf1 gene expression were found in sutures from high dose exposed individuals. Pathways related to the HTRA1/IGF axis, specifically Akt and Wnt, demonstrated evidence of increased activity. Overall our data suggest that maternal exogenous thyroxine exposure can drive calvarial growth alterations and altered suture morphology.
Efird, Chad; Traub, Shaun; Baldini, Todd; Rioux-Forker, Dana; Spalazzi, Jeffrey P; Davisson, Twana; Hawkins, Monica; McCarty, Eric
The purpose of this study was to compare the gap formation during cyclic loading, maximum repair strength, and failure mode of single-row full-thickness supraspinatus repairs performed using 2 knotless suture anchors with differing internal suture-retention mechanisms in a human cadaver model. Nine matched pairs of cadaver shoulders were used. Full-thickness tears were induced by detaching the supraspinatus tendon from the greater tuberosity. Single-row repairs were performed with either type I (Opus Magnum PI; ArthroCare, Austin, Texas) or type II (ReelX STT; Stryker, Mahwah, New Jersey) knotless suture anchors. The repaired tendon was cycled from 10 to 90 N for 500 cycles, followed by load to failure. Gap formation was measured at 5, 100, 200, 300, 400, and 500 cycles with a video digitizing system. Anchor type or location (anterior or posterior) had no effect on gap formation during cyclic loading regardless of position (anterior, P=.385; posterior, P=.389). Maximum load to failure was significantly greater (P=.018) for repairs performed with type II anchors (288±62 N) compared with type I anchors (179±39 N). Primary failure modes were anchor pullout and tendon tearing for type II anchors and suture slippage through the anchor for type I anchors. The internal ratcheting suture-retention mechanism of type II anchors may have helped this anchor outperform the suture-cinching mechanism of type I anchors by supporting significantly higher loads before failure and minimizing suture slippage, potentially leading to stronger repairs clinically. Copyright 2013, SLACK Incorporated.
Takacs, Joel D; Singh, Ameet; Case, J Brad; Mayhew, Philipp D; Giuffrida, Michelle A; Caceres, Ana V; Fox-Alvarez, W Alexander; Runge, Jeffrey J
To describe the use and outcome of a single, simple continuous, barbed suture line for prophylactic, total laparoscopic gastropexy in dogs. Multi-center, retrospective case series. Sixty-three client-owned dogs. Medical records of dogs undergoing total laparoscopic gastropexy using a barbed suture at 4 academic veterinary hospitals from 2011-2015 were reviewed. Data collected included signalment, procedure time, procedure-associated complications, short-term complications, and long-term outcome. All procedures were performed under general anesthesia in dorsal to dorsal-left oblique recumbency. Laparoscopic ports were placed on ventral midline in 1 of 3 port configurations, and 5 mm laparoscopic needle drivers were used for intracorporeal sutured gastropexy with unidirectional barbed suture. The gastropexy was positioned just caudal to the 13th rib, 2-4 cm lateral to the rectus abdominis muscle. Sixty-three dogs underwent total laparoscopic gastropexy with a single, simple continuous, barbed suture line. Median gastropexy surgery time was 70 minutes (interquartile range [IQR] 60-90 minutes). One dog sustained splenic laceration from Veress needle penetration during initial abdominal insufflation. Short term (>24 hours to 6 months postoperative) complications included incisional seroma formation (n = 2) and suture reaction (n = 1). Long term (>6 months postoperative) complications included intermittent regurgitation and chronic diarrhea in 1 dog. Fifteen dogs had postoperative ultrasound and all had intact gastropexy sites. Total laparoscopic barbed gastropexy using a single, simple continuous, barbed suture line in dogs is safe and results in an intact gastropexy long term. © 2016 The American College of Veterinary Surgeons.
Guo, Jun-Chao; Wang, Li-Zhen; Mo, Zhong-Jun; Chen, Wei; Fan, Yu-Bo
The aim of this study was to evaluate the rationality of the suture locations of distal plantar fascia (DPF) after foot amputation to avoid the risk factors of re-amputation or plantar fasciitis. The tensile strain of plantar fascia (PF) in the different regions was measured by uni-axial tensile experiment. A three-dimensional (3D) finite element model was also developed to simulate tensile behaviour of PF in weight bearing conditions. The model includes 12 bones, ligaments, PF, cartilage and soft tissues. Four suture location models for the DPF were considered: the fourth and fifth DPF were sutured on the third metatarsal, the cuboid, and both the third metatarsal and the cuboid, and one un-sutured model. The peak tensile strain of the first, second and third PF was 0.134, 0.128 and 0.138 based on the mechanical test, respectively. The fourth and fifth DPF sutured at the cuboid and the third metatarsal could offer more favourable outcomes. The peak strain of 4.859 × 10(-2), 2.347 × 10(-2) and 1.364 × 10(-2) in the first, second and third PF showed the least outcomes in stance phase. Also, peak strain and stress of the residual PF reduced to 4.859 × 10(-2) and 1.834 MPa, respectively. The stress region was redistributed on the mid-shaft of the first and third PF and the peak stress of medial cuneiform bone evidently decreased. The fourth and fifth DPF suture at the third metatarsal and cuboid was appropriate for the partial foot. The findings are expected to suggest optimal surgical plan of the DPF suture and guide further therapeutic planning of partial foot patients.
Theodoropoulos, G E; Michalopoulos, N V; Linardoutsos, D; Stamopoulos, P; Flessas, I; Tsamis, D; Zografos, G C
The isolated application of Doppler-guided haemorrhoidal artery ligation (DGHAL) may fail due to the increased reprolapse rate for high-grade haemorrhoids. DGHAL has been combined with a proctoscopic-assisted transanal rectal mucopexy of the prolapsing tissue. The technique is called rectoanal repair (RAR) and is an evolution of various mucopexy and suture haemorrhoidopexy (SHP) techniques. A prominent external component may require minimal (muco-) cutaneous excision (MMCE) of protruding anoderm or minor cutaneous excision of skin tags. Fifty-seven patients with symptomatic Goligher grade III and IV haemorrhoids underwent DGHAL followed by either RAR or SHP. In 26 cases, the addition of MMCE was necessary. No significant differences were observed between the two approaches with regards to pain scores measured with visual analogue scale (VAS). On postoperative day 1, mean pain score at rest was 5.81 (±2.23 SD) after SHP versus 5.08 (±2.35 SD) after RAR, while mean pain score at first defecation was 7.31 (±1.6 SD) versus 7.52 (±1.83 SD). There was no difference in the duration of analgesic requirements, postoperative complications and residual prolapse between the 2 procedures. The addition of MMCE did not affect postoperative pain nor analgesic requirements. With the exception of 8 patients who still had with skin tags or minimal protrusion, the remaining of patients (86 %) were asymptomatic and recurrence-free at an average follow-up of 20 months. Overall, 94.8 % of patients stated that they were satisfied with the results, and 91.2 % that they would repeat it if necessary. Performance of either SHP or RAR after DGHAL is a safe and effective surgical tactic for advanced grade haemorrhoids. Our initial results do not confirm any superiority of RAR over traditional SHP.
von Renteln, Daniel; Schmidt, Arthur; Riecken, Bettina; Caca, Karel
The endoscopic full-thickness Plicator device was initially developed to provide an endoscopic treatment option for patients with GERD. Because the endoscopic full-thickness Plicator enables rapid and easy placement of transmural sutures, comparable with surgical sutures, we used the Plicator device for endoscopic treatment or prevention of GI-wall defects. To describe the outcomes and complications of endoscopic full-thickness suturing during EMR and for the treatment of gastric-wall defects. A report of 4 cases treated with the endoscopic full-thickness suturing between June 2006 and April 2007. A large tertiary-referral center. Four subjects received endoscopic full-thickness suturing. The subjects were women, with a mean age of 67 years. Of the 4 subjects, 3 received endoscopic full-thickness suturing during or after an EMR. One subject received endoscopic full-thickness suturing for treatment of a fistula. Primary outcome measurements were clinical procedural success and procedure-related adverse events. The mean time for endoscopic full-thickness suturing was 15 minutes. In all cases, GI-wall patency was restored or ensured, and no procedure-related complications occurred. All subjects responded well to endoscopic full-thickness suturing. The resection of one GI stromal tumor was incomplete. Because of the Plicator's 60F distal-end diameter, endoscopic full-thickness suturing could only be performed with the patient under midazolam and propofol sedation. The durable Plicator suture might compromise the endoscopic follow-up after EMR. The endoscopic full-thickness Plicator permits rapid and easy placement of transmural sutures and seems to be a safe and effective alternative to surgical intervention to restore GI-wall defects or to ensure GI-wall patency during EMR procedures.
Cho, Byung-Ki; Kim, Yong-Min; Park, Kyoung-Jin; Park, Ji-Kang; Kim, Do-Kyoon
There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique. Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability. There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group. Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies. Level II, prospective comparative study. © The Author(s) 2014.
Blaker, J J; Nazhat, S N; Boccaccini, A R
A novel silver-doped bioactive glass powder (AgBG) was used to coat resorbable Vicryl (polyglactin 910) and non-resorbable Mersilk surgical sutures, thereby imparting bioactive, antimicrobial and bactericidal properties to the sutures. Stable and homogeneous coatings on the surface of the sutures were achieved using an optimised aqueous slurry-dipping technique. Dynamic mechanical analysis (DMA) was used to investigate the viscoelastic parameters of storage modulus and tandelta and thermal transitions of the as-received and composite (coated) sutures. The results generally showed that the bioactive glass coating did not affect the dynamic mechanical and thermal properties of the sutures. The in vitro bioactivity of the sutures was tested by immersion in simulated body fluid (SBF). After only 3 days of immersion in SBF, bonelike hydroxyapatite formed on the coated suture surfaces, indicating their enhanced bioactive behaviour. Resorbable sutures with bioactive coatings as fabricated here, in conjunction with 3-D textile technology, may provide attractive materials for producing 3-D scaffolds with controlled porosities for tissue engineering applications. The bactericidal properties imparted by the Ag-containing glass coating open also new opportunities for use of the composite sutures in wound healing and body wall repair.
Britt, Rebecca C; Scerbo, Mark W; Montano, Michael; Kennedy, Rebecca A; Prytz, Erik; Stefanidis, Dimitrios
A spatial secondary task developed by the authors was used to measure the mental workload of the participant when transferring suturing skills from a box simulator to more realistic surgical conditions using a fresh cadaver. We hypothesized that laparoscopic suturing on genuine bowel would be more challenging than on the Fundamentals of Laparoscopic Surgery (FLS)-simulated bowel as reflected in differences on both suturing and secondary task scores. We trained 14 surgical assistant students to FLS proficiency in intracorporeal suturing. Participants practiced suturing on the FLS box for 30 minutes and then were tested on both the FLS box and the bowel of a fresh cadaver using the spatial, secondary dual-task conditions developed by the authors. Suturing times increased by >333% when moving from the FLS platform to the cadaver F(1,13) = 44.04, P < .001. The increased completion times were accompanied by a 70% decrease in secondary task scores, F(1,13) = 21.21, P < .001. The mental workload associated with intracorporeal suturing increases dramatically when trainees transfer from the FLS platform to human tissue under more realistic conditions of suturing. The increase in mental workload is indexed by both an increase in suturing times and a decrease in the ability to attend to the secondary task. Copyright © 2015 Elsevier Inc. All rights reserved.
Younesi, Mousa; Knapik, Derrick M; Cumsky, Jameson; Donmez, Baris Ozgur; He, Ping; Islam, Anowarul; Learn, Greg; McClellan, Philip; Bohl, Michael; Gillespie, Robert J; Akkus, Ozan
Flexor tendon lacerations are traditionally repaired by using non-absorbable monofilament sutures. Recent investigations have explored to improve the healing process by growth factor delivery from the sutures. However, it is difficult to conjugate growth factors to nylon or other synthetic sutures. This study explores the performance of a novel electrochemically aligned collagen suture in a flexor tendon repair model with and without platelet derived growth factor following complete tendon laceration in vivo. Collagen suture was fabricated via electrochemical alignment process. Heparin was covalently bound to electrochemically aligned collagen sutures (ELAS) to facilitate affinity bound delivery of platelet-derived growth factor-BB (PDGF-BB). Complete laceration of the flexor digitorum profundus in the third digit of the foot was performed in 36 skeletally mature White Leghorn chickens. The left foot was used as the positive control. Animals were randomly divided into three groups: control specimens treated with standard nylon suture (n=12), specimens repaired with heparinated ELAS suture without PDGF-BB (n=12) and specimens repaired with heparinated ELAS suture with affinity bound PDGF-BB (n=12). Specimens were harvested at either 4weeks or 12weeks following tendon repair. Differences between groups were evaluated by the degree of gross tendon excursion, failure load/stress, stiffness/modulus, absorbed energy at failure, elongation/strain at failure. Quantitative histological scoring was performed to assess cellularity and vascularity. Closed flexion angle measurements demonstrated no significant differences in tendon excursion between the study groups at 4 or 12weeks. Biomechanical testing showed that the group treated with PDGF-BB bound heparinated ELAS suture had significantly higher stiffness and failure load (p<0.05) at 12-weeks relative to both heparinated ELAS suture and nylon suture. Similarly, the group treated with PDGF-BB bound suture had significantly
Stefanidis, Dimitrios; Wang, Fikre; Korndorffer, James R; Dunne, J Bruce; Scott, Daniel J
Intracorporeal suturing is one of the most difficult laparoscopic tasks. The purpose of this study was to assess the impact of robotic assistance on novice suturing performance, safety, and workload in the operating room. Medical students (n = 34), without prior laparoscopic suturing experience, were enrolled in an Institutional Review Board-approved, randomized protocol. After viewing an instructional video, subjects were tested in intracorporeal suturing on two identical, live, porcine Nissen fundoplication models; they placed three gastro-gastric sutures using conventional laparoscopic instruments in one model and using robotic assistance (da Vinci) in the other, in random order. Each knot was objectively scored based on time, accuracy, and security. Injuries to surrounding structures were recorded. Workload was assessed using the validated National Aeronautics and Space Administration (NASA) task load index (TLX) questionnaire, which measures the subjects' self-reported performance, effort, frustration, and mental, physical, and temporal demands of the task. Analysis was by paired t-test; p < 0.05 was considered significant. Compared with laparoscopy, robotic assistance enabled subjects to suture faster (595 +/- 22 s versus 459 +/- 137 s, respectively; p < 0.001), achieve higher overall scores (0 +/- 1 versus 95 +/- 128, respectively; p < 0.001), and commit fewer errors per knot (1.15 +/- 1.35 versus 0.05 +/- 0.26, respectively; p < 0.001). Subjects' overall score did not improve between the first and third attempt for laparoscopic suturing (0 +/- 0 versus 0 +/- 0; p = NS) but improved significantly for robotic suturing (49 +/- 100 versus 141 +/- 152; p < 0.001). Moreover, subjects indicated on the NASA-TLX scale that the task was more difficult to perform with laparoscopic instruments compared with robotic assistance (99 +/- 15 versus 57 +/- 23; p < 0.001). Compared with standard laparoscopy, robotic assistance significantly improved intracorporeal suturing
Ozer, M Tahir; Eryilmaz, Mehmet; Coskun, Kagan; Demirbas, Sezai; Uzar, A Ihsan; Kozak, Orhan
Blunt and penetrating hepatic injuries are conditions that are frequently encountered in emergency surgeries, and they involve high mortality morbidity. In the handling of such injuries, methods ranging from the application of simple cauterization and suturing for hemostasis to hepatic lobectomies, which might involve the removal of the greater part of the organ, have been defined. Due to the organ's fragility and susceptibility to bleeding, elective hepatic resections necessitate both surgical experience and technological equipment. Therefore, the demand still exists for an affordable and easy-to-use-method that could be applied by all centers. To meet this demand, we have developed a method of hemorrhage control via sutures supported by absorbable plaques that provide effective compression and prevent the suture from cutting the tissue during the application of the sutures in the treatment of such fragile organs as the liver. In our method, we have achieved hemostasis by bilaterally compressing the tissue through strong ties after placing, on the part of the tissue on which the sutures are applied, absorbable and flexible plaques that prevent the suture from cutting the tissue during the application of a polyglactin suture to the solid organ. To prevent dislocation of the plaques, we have fastened the sutures by reeving them through the holes made in the plaques. We have demonstrated the success and the practicality of our method by applying it on four pigs; we experimentally inflicted hepatic injuries on two pigs, and we performed resection on the other two pigs. The hepatic hemorrhages we developed in both of the animals were successfully restrained by the use of our method. On the other hand, two resections were performed on the right and left lobes of the other two animals. There were no hemorrhages during the surgery, and the procedure took 45 minutes in total. No postoperative complications occurred. While the liver function test values were high on the
Milchteim, Charles; Branch, Eric A; Maughon, Ty; Hughey, Jay; Anz, Adam W
Longitudinal meniscus tears are commonly encountered in clinical practice. Meniscus repair devices have been previously tested and presented; however, prior studies have not evaluated repair construct designs head to head. This study compared a new-generation meniscus repair device, SpeedCinch, with a similar established device, Fast-Fix 360, and a parallel repair construct to a crossed construct. Both devices utilize self-adjusting No. 2-0 ultra-high molecular weight polyethylene (UHMWPE) and 2 polyether ether ketone (PEEK) anchors. Crossed suture repair constructs have higher failure loads and stiffness compared with simple parallel constructs. The newer repair device would exhibit similar performance to an established device. Controlled laboratory study. Sutures were placed in an open fashion into the body and posterior horn regions of the medial and lateral menisci in 16 cadaveric knees. Evaluation of 2 repair devices and 2 repair constructs created 4 groups: 2 parallel vertical sutures created with the Fast-Fix 360 (2PFF), 2 crossed vertical sutures created with the Fast-Fix 360 (2XFF), 2 parallel vertical sutures created with the SpeedCinch (2PSC), and 2 crossed vertical sutures created with the SpeedCinch (2XSC). After open placement of the repair construct, each meniscus was explanted and tested to failure on a uniaxial material testing machine. All data were checked for normality of distribution, and 1-way analysis of variance by ranks was chosen to evaluate for statistical significance of maximum failure load and stiffness between groups. Statistical significance was defined as P < .05. The mean maximum failure loads ± 95% CI (range) were 89.6 ± 16.3 N (125.7-47.8 N) (2PFF), 72.1 ± 11.7 N (103.4-47.6 N) (2XFF), 71.9 ± 15.5 N (109.4-41.3 N) (2PSC), and 79.5 ± 25.4 N (119.1-30.9 N) (2XSC). Interconstruct comparison revealed no statistical difference between all 4 constructs regarding maximum failure loads (P = .49). Stiffness values were also similar
Gnandt, Ryan J; Smith, Jennifer L; Nguyen-Ta, Kim; McDonald, Lucas; LeClere, Lance E
To determine which suture design, high-tensile strength tape or high-tensile strength suture, performed better at securing human tissue across 4 selected suture techniques commonly used in tendinous repair, by comparing the total load at failure measured during a fixed-rate longitudinal single load to failure using a biomechanical testing machine. Matched sets of tendon specimens with bony attachments were dissected from 15 human cadaveric lower extremities in a manner allowing for direct comparison testing. With the use of selected techniques (simple Mason-Allen in the patellar tendon specimens, whip stitch in the quadriceps tendon specimens, and Krackow stitch in the Achilles tendon specimens), 1 sample of each set was sutured with a 2-mm braided, nonabsorbable, high-tensile strength tape and the other with a No. 2 braided, nonabsorbable, high-tensile strength suture. A total of 120 specimens were tested. Each model was loaded to failure at a fixed longitudinal traction rate of 100 mm/min. The maximum load and failure method were recorded. In the whip stitch and the Krackow-stitch models, the high-tensile strength tape had a significantly greater mean load at failure with a difference of 181 N (P = .001) and 94 N (P = .015) respectively. No significant difference was found in the Mason-Allen and simple stitch models. Pull-through remained the most common method of failure at an overall rate of 56.7% (suture = 55%; tape = 58.3%). In biomechanical testing during a single load to failure, high-tensile strength tape performs more favorably than high-tensile strength suture, with a greater mean load to failure, in both the whip- and Krackow-stitch models. Although suture pull-through remains the most common method of failure, high-tensile strength tape requires a significantly greater load to pull-through in a whip-stitch and Krakow-stitch model. The biomechanical data obtained in the current study indicates that high-tensile strength tape may provide better repair
Ghosh, Sudip; Niklewski, Paul; Roy, Sanjoy
Background: Laparoscopic surgery is increasingly replacing the open procedure because of its many patient-related benefits that are well aligned with policies and programs that seek to optimize health system performance. However, widespread adoption of laparoscopic surgery has been slow, in part, because of the complexity of laparoscopic suturing. The objective of this study was to review the clinical and economic impacts of laparoscopic suturing in key procedures and to assess its role as a barrier to the broader adoption of laparoscopic surgery. Database: A medical literature search of MEDLINE, EMBASE, and BIOSIS from January 2010 through June 2016 identified 47 relevant articles. Conclusion: Laparoscopic suturing and intracorporeal knot tying may result in extended surgical time, complications, and surgeon errors, while improving patient quality of life through improved cosmesis, diet toleration, and better bowel movements. Despite advancement in surgical techniques and the availability of newer surgical tools, the complexity of laparoscopic suturing continues to be a barrier to greater adoption of MIS. The results of the study underscore the need for development of proficiency in laparoscopic suturing, which may help improve patient outcomes and reduce healthcare costs. PMID:28694682
Gordon-Evans, Wanda J; Dunning, Diane; Johnson, Ann L; Knap, Kim E
To determine whether carprofen, a commercially available NSAID, would decrease perceived exertion and signs of pain in dogs and therefore increase muscle mass and hind limb function without decreasing range of motion after lateral fabellar suture stabilization. Randomized, blinded, controlled clinical trial. 35 dogs with cranial cruciate ligament rupture and lateral fabellar suture stabilization followed by rehabilitation. All dogs underwent surgical stabilization of cranial cruciate ligament rupture by placement of a lateral fabellar suture. Dogs received carprofen (2.2 mg/kg [1 mg/lb], PO, q 12 h) for the first 7 days after surgery and underwent concentrated rehabilitation exercises during weeks 3, 5, and 7 after surgery. Eighteen dogs also received carprofen (2.2 mg/kg, PO, q 12 h) during the weeks of concentrated rehabilitation. Outcomes were measured by a single investigator, who was blinded to group assignments, using pressure platform gait analysis, goniometry, thigh circumference, and mean workout speed at a consistent level of exertion. There were no differences between the 2 groups in ground reaction forces, thigh circumference, or exertion (mean workout speed) over time or at any individual time point. However, both groups improved significantly over time for all outcome measures. Providing carprofen to dogs during concentrated rehabilitation after lateral fabellar suture stabilization did not improve hind limb function, range of motion, or thigh circumference, nor did it decrease perceived exertion, compared with control dogs. Carprofen was not a compulsory component of a physical therapy regimen after lateral fabellar suture stabilization.
Arantes, Henrique Lopes; Rosique, Rodrigo Gouvêa; Rosique, Marina Junqueira Ferreira; Mélega, Jose Marcos
The formation of seromas after abdominoplasty is a highly prevalent complication that disturbs both the patient and the surgeon. Aspiratory drainage and adhesion sutures (Baroudi suture) are widely used to prevent this complication. This study evaluated the effectiveness of drains in preventing seromas. This retrospective study investigated women submitted to classic abdominoplasty with adhesion sutures. The women were divided into two groups. Group 1 comprised 28 individuals who received no drains, and group 2 consisted of 32 patients that had drains placed. Clinical evaluation of the patients was performed 7 days, 14 days, 1 month, 2 months, 4 months, and 6 months postoperatively. Statistical analysis was accomplished via Fisher's exact test. Group 1 had one case of seroma (3.5%), clinically detected between the first and second postoperative months, whereas group 2 had one case (3.12%) detected 14 days postoperatively. Fisher's test showed a P value of 1.000 (not statistically significant), for a 95% confidence interval of 0.05 to 14.08 and an odds ratio of 0.8387. Clinical evaluation showed no statistical difference in the incidence of seromas after abdominoplasty with adhesion sutures between the patients who received drains and those who did not. The use of adhesion sutures is an effective measure for preventing seromas with no need for additional surgical measures.
May, William N; Castro-Combs, Juan; Kashiwabuchi, Renata T; Tattiyakul, Woranart; Qureshi-Said, Saima; Hirai, Flavio; Behrens, Ashley
To determine the effects of single radial or horizontal suture placement in 2-step clear corneal incision (CCI) wound apposition and permeability to particles of India ink. Five fresh human globes were included. Two 25-gauge needles connected to a saline solution bag and to a digital manometer were inserted through the limbus, 120 degrees apart from each other. Four 2-step CCIs (2.75 mm wide and 3 mm length) were constructed in each cornea. Incisions were divided into 3 groups: single radial suture (SRS), single horizontal suture (SHS), and unsutured group. Optical coherence tomography (OCT) was performed before and after suture placement. With a preset 10 mm Hg intraocular pressure (IOP), India ink was applied to the incision site and a standardized sudden IOP fluctuation was induced. OCT and superficial images were recorded before and after suture placement. India ink inflow and internal and external CCI gapping were outlined and measured by planimeter. The area and linear distance of India ink inflow after pressure challenge in all study groups were higher when compared with pre-pressure measurements; however, this increase was significant in the SRS and SHS groups (P < 0.05). Additionally, SRS placement significantly increased inner wound gapping (P = 0.018), and SHS significantly widened outer wound gape (P = 0.02). Well-constructed unsutured 2-step CCI seems to be more efficient at preventing bacterial-sized particles inflow during sudden changes in IOP, and it seems to offer better wound apposition as assessed by OCT.
Asciak, Rachelle; Addala, Dinesh; Karimjee, Juzer; Rana, Maaz Suhail; Tsikrika, Stamatoula; Hassan, Maged Fayed; Mercer, Rachel Mary; Hallifax, Robert John; Wrightson, John Matthew; Psallidas, Ioannis; Benamore, Rachel; Rahman, Najib Mahboob
Chest drains often become displaced and require replacement, adding unnecessary risks to patients. Simple measures such as suturing of the drain may reduce fall-out rates; however, there is no direct data to demonstrate this and no standardized recommended practice that is evidence based. The study aimed to analyze the rate of chest drain fall out according to suturing practice. Retrospective analysis of all chest drain insertions (radiology and pleural teams) in 2015-2016. Details of chest drain fall out were collected from patient electronic records. Drain "fall out" was pre-hoc defined as the drain tip becoming dislodged outside the pleural cavity unintentionally before a clinical decision was taken to remove the drain. A total of 369 chest drains were inserted: sutured (n = 106, 28.7%; 44 male [41.5%], median age 74 [interquartile range (IQR) 21] years), and unsutured (n = 263, 71.3%; 139 male [52.9%], median age 68 [IQR 21] years). Of the sutured drains, 7 (6.6%) fell out after a mean of 3.3 days (SD 2.6) compared to 39 (14.8%; p = 0.04) unsutured drains falling out after a mean of 2.7 days (SD 2.0; p = 0.8). Within the limits of this retrospective analysis, these results -suggest that suturing of drains is associated with lower fall-out rates. © 2018 S. Karger AG, Basel.
Shin, So-Jin; Chung, Hyewon; Kwon, Sang-Hoon; Cha, Soon-Do; Cho, Chi-Heum
To describe a simple and efficient technique for suturing the vaginal cuff in robotic-assisted single-site hysterectomy using barbed suture and a straight needle. Consecutive patients undergoing robotic-assisted single-site hysterectomy from February 2014 to August 2015 at Dong San Hospital, Keimyung University were included. Surgeons used two barbed sutures in a running fashion to close the vaginal cuff. A barbed suture was exclusively used with a straightened needle in upward direction from posterior vaginal cuff to anterior vaginal cuff which played a pivotal role for closure. A total of 100 patients underwent robotic-assisted single-site hysterectomy. The total operation time was 132.5 min and vaginal cuff closure time was 12.0 min. There were no postoperative complications; vaginal cuff dehiscence, vaginal cuff infection, and vaginal bleeding that require surgical intervention or admission. The use of barbed suture with straightened needle to close the vaginal cuff in robotic-assisted single-site hysterectomy is easy to perform and demonstrates safety and efficacy. This technique offers secure, fast, and effective incision closure.
Meng, Yifan; Wu, Peng; Deng, Dongrui; Wu, Jianli; Lin, Xingguang; Beejadhursing, Rajluxmee; Zha, Ying; Qiao, Fuyuan; Feng, Ling; Liu, Haiyi; Zeng, Wanjiang
Abstract Patients with total placenta previa and past history of cesarean delivery often experience overwhelming hemorrhage during childbirth. In order to control intraoperative and postoperative bleeding, we propose a novel multifaceted spiral suture of the lower uterine segment which directly sutures the bleeding site. To evaluate the efficacy and safety of multifaceted spiral suture, a retrospective study was conducted using data from 33 patients with total placenta praevia and caesarean history. All participants underwent multifaceted spiral suture and no patient experienced uncontrollable bleeding or underwent hysterectomy. The average blood loss of all patients involved was 1327.3 ± 1244.1 mL. Five patients reported blood loss exceeding 3000 mL (15.15%), and the highest reached to 4000 mL. No complications such as fever, pyometra, synechiae, or uterine necrosis were observed. Three cases (3/33, 9.09%) reported hematuria in the first 3 days following surgery and spontaneous resolution were observed within 3 to 7 days following insertion of indwelling catheters. No complaints were received during 6-month follow-up visits. These findings suggest that multifaceted spiral suture is a practical, feasible, and promising technique in potentially minimizing postpartum bleeding and avoiding hysterectomy for patients with placenta praevia or accrete. PMID:29245338
Lim, Sangtaeck; Ghosh, Sudip; Niklewski, Paul; Roy, Sanjoy
Laparoscopic surgery is increasingly replacing the open procedure because of its many patient-related benefits that are well aligned with policies and programs that seek to optimize health system performance. However, widespread adoption of laparoscopic surgery has been slow, in part, because of the complexity of laparoscopic suturing. The objective of this study was to review the clinical and economic impacts of laparoscopic suturing in key procedures and to assess its role as a barrier to the broader adoption of laparoscopic surgery. A medical literature search of MEDLINE, EMBASE, and BIOSIS from January 2010 through June 2016 identified 47 relevant articles. Laparoscopic suturing and intracorporeal knot tying may result in extended surgical time, complications, and surgeon errors, while improving patient quality of life through improved cosmesis, diet toleration, and better bowel movements. Despite advancement in surgical techniques and the availability of newer surgical tools, the complexity of laparoscopic suturing continues to be a barrier to greater adoption of MIS. The results of the study underscore the need for development of proficiency in laparoscopic suturing, which may help improve patient outcomes and reduce healthcare costs.
Boo, Yoon Jung; Rohleder, Stephan; Muensterer, Oliver J.
Background Closure of the posterolateral defect in some cases of congenital diaphragmatic hernia (CDH) can be difficult. Percutaneous transcostal suturing is often helpful to create a complete, watertight closure of the diaphragm. A challenge with the technique is passing the needle out the same tract that it entered so that no skin is caught when the knots are laid down into the subcutaneous tissue. This report describes a novel technique using a Tuohy needle to percutaneously suture the posterolateral defect during thoracoscopic repair of CDH. Case We report a case of a 6-week-old infant who presented with a CDH and ipsilateral intrathoracic kidney that was repaired using thoracoscopic approach. The posterolateral part of the defect was repaired by percutaneous transcostal suturing and extracorporeal knot tying. To assure correct placement of the sutures and knots, a Tuohy needle was used to guide the suture around the rib and out through the same subcutaneous tract. The total operative time was 145 minutes and there were no perioperative complications. The patient was followed up for 3 months, during which there was no recurrence. Conclusion Our percutaneous Tuohy technique for closure of the posterolateral part of CDH enables a secure, rapid, and tensionless repair. PMID:28804698
Boo, Yoon Jung; Rohleder, Stephan; Muensterer, Oliver J
Background Closure of the posterolateral defect in some cases of congenital diaphragmatic hernia (CDH) can be difficult. Percutaneous transcostal suturing is often helpful to create a complete, watertight closure of the diaphragm. A challenge with the technique is passing the needle out the same tract that it entered so that no skin is caught when the knots are laid down into the subcutaneous tissue. This report describes a novel technique using a Tuohy needle to percutaneously suture the posterolateral defect during thoracoscopic repair of CDH. Case We report a case of a 6-week-old infant who presented with a CDH and ipsilateral intrathoracic kidney that was repaired using thoracoscopic approach. The posterolateral part of the defect was repaired by percutaneous transcostal suturing and extracorporeal knot tying. To assure correct placement of the sutures and knots, a Tuohy needle was used to guide the suture around the rib and out through the same subcutaneous tract. The total operative time was 145 minutes and there were no perioperative complications. The patient was followed up for 3 months, during which there was no recurrence. Conclusion Our percutaneous Tuohy technique for closure of the posterolateral part of CDH enables a secure, rapid, and tensionless repair.
Sakallioğlu, Oner; Düzer, Sertaç; Kapusuz, Zeliha
The aim of our study was to investigate the efficiacy of the suturation technique after completing the tonsillectomy procedure for posttonsillectomy pain control in adult patients. August 2010-February 2011, 44 adult patients, ages ranged from 16 to 41 years old who underwent tonsillectomy at Elaziğ Training and Research Hospital Otorhinolaryngology Clinic were included to the study. After tonsillectomy procedure, anterior and posterior tonsillar archs were sutured each other and so, the area of tonsillectomy lodges which covered with mucosa were increased. Twenty two patients who applied posttonsillectomy suturation were used as study group and remnant 22 patients who did not applied posttonsillectomy suturation were used as control group. The visual analogue score (VAS) was used to evaluate the postoperative pain degree (0 no pain, 10 worst pain). ANOVA test (two ways classification with repeated measures) was used for statistical analysis of VAS values. P < 0.05 was accepted as statistically significant. The effect of time (each post-operative day) on VAS values was significant. The mean VAS values between study and control group on post-operative day 1st, 3rd, 7th, and 10th were statistically significant (P < 0.05). The severity of posttonsillectomy pain was less in study group patients than control group patients. The suturation of anterior and posterior tonsillar archs after tonsillectomy procedure was found effective to alleviate the posttonsillectomy pain in adult patients.
Zhou, Wei; Lv, Ran; Wang, Xianfa; Mou, Yiping; Cai, Xiujun; Herr, Ingrid
Suture closure and stapler closure of the pancreatic remnant after distal pancreatectomy are the techniques used most often. The ideal choice remains a matter of debate. Five bibliographic databases covering 1970 to July 2009 were searched. Sixteen articles met the inclusion criteria. Stapler closure was performed in 671 patients, while suture closure was conducted in 1,615 patients. The pancreatic fistula rate ranged from 0% to 40.0% for stapler closure of the pancreatic stump and from 9.3% to 45.7% for the suture closure technique. There were no significant difference between the stapler and suture closure groups with respect to the pancreatic fistula formation rate (22.1% vs 31.2%; odds ratio, .85; 95% confidence interval, .66-1.08), although there was a trend toward favoring stapler closure. In 4 studies including 437 patients, stapler closure was associated with a trend (not statistically significant) toward a reduction in intra-abdominal abscess (odds ratio, .53; 95% confidence interval, .24-1.15). No significant differences occur between suture and stapler closure with respect to the pancreatic fistula or intra-abdominal abscess after distal pancreatectomy, though there is a trend favoring stapler closure. Copyright © 2010 Elsevier Inc. All rights reserved.
Rosa, Cristiane B.; Habib, Fernando Antonio L.; de Araújo, Telma M.; dos Santos, Jean N.; Cangussu, Maria Cristina T.; Barbosa, Artur Felipe S.; de Castro, Isabele Cardoso V.; Soares, Luiz Guilherme P.; Pinheiro, Antonio L. B.
A quick bone formation after maxillary expansion would reduce treatment timeand the biomodulating effects of LED light could contribute for it. The aim of this study was to analyze the effect of LED phototherapy on the acceleration of bone formation at the midpalatal suture after maxilla expansion. Thirty rats divided into 6 groups were used on the study at 2 time points - 7 days: Control; Expansion; and Expansion + LED; and 14 days: Expansion; Expansion + LED in the first week; Expansion and LED in the first and second weeks. LED irradiation occurred at every 48 h during 2 weeks. Expansion was accomplished using a spatula and maintained with a triple helicoid of 0.020" stainless steel orthodontic wire. A LED light (λ850 ± 10nm, 150mW ± 10mW, spot of 0.5cm2, t=120 sec, SAEF of 18J/cm2) was applied in one point in the midpalatal suture immediately behind the upper incisors. Near infrared Raman spectroscopic analysis of the suture region was carried and data submitted to statistical analyzes (p≤0.05). Raman spectrum analysis demonstrated that irradiation increased hydroxyapatite in the midpalatal suture after expansion. The results of this indicate that LED irradiation; have a positive biomodulation contributing to the acceleration of bone formation in the midpalatal suture after expansion procedure.
Weiss, William M; Saucedo, Ramon P; Robinson, John D; Lo, Chung-Chieh Jason; Morris, Randal P; Panchbhavi, Vinod K
Refractory cases of Achilles tendinopathy amenable to surgery may include reattachment of the tendon using suture anchors. However, there is paucity of information describing the optimal insertion angle to maximize the tendon footprint and anchor stability in the calcaneus. The purpose of this investigation is to compare the fixation strength of suture anchors inserted at 90° and 45° (the Deadman's angle) relative to the primary compressive trabeculae of the calcaneus. A total of 12 matched pairs of adult cadaveric calcanei were excised and potted to approximate their alignment in vivo. Each pair was implanted with 5.5-mm bioabsorbable suture anchors placed either perpendicular (90°) or oblique (45°) to the primary compressive trabeculae. A tensile load was applied until failure of anchor fixation. Differences in failure load and stiffness between anchor fixation angles were determined by paired t-tests. No significant differences were detected between perpendicular and oblique suture anchor insertion relative to primary compressive trabeculae in terms of load to failure or stiffness. This investigation suggests that the fixation strength of suture anchors inserted perpendicular to the primary compression trabeculae and at the Deadman's angle are possibly comparable. Biomechanical comparison study.
Laparoscopic splenectomy is a well described gold standard procedure for various indications. One of the key steps during laparoscopic splenectomy is the hilar pedicle vessels control, which can be challenging in most cases. Most centres around the world recommend the use Ligaclib or endovascular staplers as Methods of choice for hilar pedicle control but the issue is the cost and efficiency of the laparoscopic haemostatic devices. A descriptive retrospective study of patients who had laparoscopic splenectomy from 2013 to present. Hilar splenic vessel control was done with suture ligation. We looked at outcomes of patients offered this technique, complications of this technique, and describing the technique of hilar control in laparoscopic splenectomy. Total of 27 patients had laparoscopic splenectomy with splenic hilar pedicle control with suture ligation. Mean operative time, mean blood volume loss, length of hospital stay, postoperative complications conversion to laparotomy. Laparoscopic hilar pedicle control with suture ligation is safe and effective for the patient in our hospital setting.
Kague, Erika; Roy, Paula; Asselin, Garrett; Hu, Gui; Stanley, Alexandra; Albertson, Craig; Simonet, Jacqueline; Fisher, Shannon
During growth, individual skull bones overlap at sutures, where osteoblast differentiation and bone deposition occur. Mutations causing skull malformations have revealed some required genes, but many aspects of suture regulation remain poorly understood. We describe a zebrafish mutation in osterix/sp7, which causes a generalized delay in osteoblast maturation. While most of the skeleton is patterned normally, mutants have specific defects in the anterior skull and upper jaw, and the top of the skull comprises a random mosaic of bones derived from individual initiation sites. Osteoblasts at the edges of the bones are highly proliferative and fail to differentiate, consistent with global changes in gene expression. We propose that signals from the bone itself are required for orderly recruitment of precursor cells and growth along the edges. The delay in bone maturation caused by loss of Sp7 leads to unregulated bone formation, revealing a new mechanism for patterning the skull and sutures. PMID:26992365
Ahn, Jin Hwan; Wang, Joon Ho; Lim, Hong Chul; Bae, Ji Hoon; Park, Joon Soo; Yoo, Jae Chul; Shyam, Ashok Kumar
Transection injury (complete radial tear, root tear) in the posterior horn of medial meniscus will lead to loss of hoop strain, extrusion of the meniscus and early degenerative changes. The posterior horn of medial meniscus is amenable to repair due to its good blood supply and repair is the procedure of choice for these injuries. In cases of transection of the medial meniscus posterior horn, the meniscus can be repaired by a pull out suture technique using trans-septal portal. The single transosseous pull out suturing technique is a point fixation technique with limited contact area having low and inhomogeneous contact pressure. This article describes a double transosseous pull out suture technique using trans-septal portal for the repair of transection of posterior horn of medial meniscus. Use of double transosseous technique provides more secure fixation, more homogeneous and wider contact pressure area between meniscus and the bone, improving the healing potential of the repair.
Metzger, U; Weber, W; Weber, E; Linggi, J; Buchmann, P; Largiadèr, F
A retrospective study was carried out on 88 hand sewn and 34 stapled anastomoses following anterior resection to evaluate the impact of suture technique on local recurrence rate. The patient groups were comparable with one exception: there were significa