Stephen J. Wallace MD, Lauren M. Mioten MD, Robert M. Havey MS, Muturi G. Muriuki PhD, Jason H. Ko MD

Purpose:

Conventional suture repairs, when stressed, fail by suture rupture, knot slippage, or suture pull-through, when the suture cuts through the intervening tissue. The purpose of this study was to compare the biomechanical properties of flexor tendon repairs using a novel mesh suture with traditional suture repairs.

Methods:

Sixty human cadaveric flexor digitorum profundus tendons were harvested and assigned to 1 of 3 suture repair groups: 3-0 and 4-0 braided poly-blend suture or 1-mm diameter mesh suture. All tendons were repaired using a 4-strand core cruciate suture configuration. Each tendon repair underwent linear loading or cyclic loading until failure. Outcome measures included yield strength, ultimate strength, the number of cycles and load required to achieve 1-mm and 2-mm gap formation, and failure.

Results:

Mesh suture repairs had significantly higher yield and ultimate force values when compared with 3-0 and 4-0 braided poly-blend suture repairs under linear testing. The average force required to produce repair gaps was significantly higher in mesh suture repairs than in conventional suture. Mesh suture repairs endured a significantly greater number of cycles and force applied before failure compared with both 3-0 and 4-0 conventional suture.

Conclusions:

This ex vivo biomechanical study of flexor tendon repairs using a novel mesh suture reveals significant increases in average yield strength, ultimate strength, and average force required for gap formation and repair failure with mesh suture repairs compared with conventional sutures.

Clinical relevance:

Mesh suture-based flexor tendon repairs could lead to improved healing at earlier time points. The findings could allow for earlier mobilization, decreased adhesion formation, and lower rupture rates after flexor tendon repairs. (J Hand Surg Am. 2019;- (-):-e-. Copyright _ 2018 by the American Society for Surgery of the Hand. All rights reserved.)

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Mesh Suture Repairs of Contaminated Incisional Hernias

Gregory A. Dumaniana, Steven T. Laniera, Jason M. Souzaa, Mimi Wu Youngb, Alexei S. Mlodinow, Anne-Marie Bollerb, Kyle H. Muellerb, Amy L. Halversonb, Michael F. McGeeb, Jonah J. Stulbergb

Background:

We sought to evaluate the results of a new mesh sutured repair technique for closure of contaminated incisional hernias.

Methods:

48 patients with contaminated hernias 5 cmwide or greater by CT scan were closed with mesh sutures. Surgical site occurrence, infections, and hernia recurrence were compared to similar patient series reported in the literature.

Results:

Of the 48 patients, 20 had clean-contaminated wounds, 16 had contaminated wounds, and 12 were infected. 69% of the patients underwent an anterior perforator sparing components release for hernias that averaged 10.5 cm transversely (range 5 cme25 cm). SSO occurred in 27% of patients while SSI was 19%. There were no fistulas or delayed suture sinuses. With a mean follow-up of almost 12 months, 3 midline hernias recurred (6%). In these same patients, three parastomal hernias repaired with mesh sutures failed out of 4 attempted for a total failure rate of 13%.

Conclusion:

Mesh sutured closure represents a simplified and effective surgical strategy for contaminated midline incisional hernia repair.

© 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).


Rotator Cuff Repair With a Novel Mesh Suture: An Ex Vivo Assessment of Mechanical Properties

Tao Zhang,1,2 Taku Hatta,1 Andrew R. Thoreson,1 ChengChang Lu,1 Scott P. Steinmann,1 Steven L. Moran,1 Chunfeng Zhao1


1Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, Minnesota 55905,
2Joint Surgery and Sports Medicine, Jinan Central Hospital, Shandong 250013, China Received 8 March 2017; accepted 29 July 2017Published online 1 August 2017 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/jor.23668

ABSTRACT: Surgical repair is a common treatment for rotator cuff tear; however, the retear rate is high. A high degree of suture repair strength is important to ensure rotator cuff integrity for healing. The purpose of this study was to compare the mechanical performance of rotator cuffs repaired with a mesh suture versus traditional polydioxanone suture II and FiberWire sutures in a canine in vitro model. Seventy-two canine shoulders were harvested. An infraspinatus tendon tear was created in each shoulder. Two suture techniques—simple interrupted sutures and two-row suture bridge—were used to reconnect the infraspinatus tendon to the greater tuberosity, using three different suture types: Mesh suture, polydioxanone suture II, or FiberWire. Shoulders were loaded to failure under displacement control at a rate of 20 mm/min. Failure load was compared between suture types and techniques. Ultimate failure load was significantly higher in the specimens repaired with mesh suture than with polydioxanone suture II or FiberWire, regardless of suture technique. There was no significant difference in stiffness among the six groups, with the exception that FiberWire repairs were stiffer than polydioxanone suture II repairs with the simple interrupted technique. All specimens failed by suture pull-out from the tendon. Based on our biomechanical findings, rotator cuff repair with the mesh suture might provide superior initial strength against failure compared with the traditional polydioxanone suture II or FiberWire sutures. Use of the mesh suture may provide increased initial fixation strength and decrease gap formation, which could result in improved healing and lower re-tear rates following rotator cuff repair. _ 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:987–992, 2018.

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Mesh Sutured Repairs of Abdominal Wall Defects

Steven T Lanier MD, Gregory A Dumanian MD, Sumanas W Jordan MD, PhD, Kyle R Miller, Nadia A Ali, Stuart R Stock PhD

Background:

A new closure technique is introduced, which uses strips of microporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes.

Methods:

Strips of macroporous polypropylene mesh of 2 cm width were passed through the abdominal wall and tied as simple interrupted sutures. The surgical technique and surgical outcomes are presented.

Results:

107 patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias.

Conclusions:

Mesh sutured repairs reliably appose tissue under tension using concepts of force distribution and resistance to suture pull-through. The technique reduces the amount of foreign material required in comparison to sheet meshes, and avoids the shortcomings of monofilament sutures. Mesh sutured closures seem to be tolerant of bacterial contamination with low hernia recurrence rates and have replaced our routine use of mesh sheets and bioprosthetic grafts. (Plast Reconstr Surg Glob Open 2016;4:e1060; doi: 10.1097/GOX.0000000000001060; Published online 28 September 2016.)


In Vivo Evaluation of a Novel Mesh Suture Design for Abdominal Wall Closure

Jason M Souza MD, Zari P Dumanian, Anandev N Gurjala MD MS, Gregory A Dumanian MD

Background:

The authors present a novel mesh suture design aimed at minimizing the early laparotomy dehiscence that drives ventral hernia formation. The authors hypothesized that modulation of the suture-tissue interface through use of a macroporous structure and increased aspect ratio (width-toheight ratio) would decrease the suture pull-through that leads to laparotomy dehiscence.

Methods:

Incisional hernias were produced in 30 rats according to an established hernia model. The rat hernias were randomized to repair with either two 5-0 polypropylene sutures or two midweight polypropylene mesh sutures. Standardized photographs were taken before repair and 1 month after repair. Edge-detection software was used to define the border of the hernia defect and calculate the defect area. Histologic analysis was performed on all mesh suture specimens.

Results:

Seventeen hernias were repaired with mesh sutures and 13 were repaired with conventional sutures. The mean area of the recurrent defects following repair with mesh suture was 177.8 ± 27.1 mm2, compared with 267.3 ± 34.1 mm2 following conventional suture repair. This correlated to a 57.4 percent reduction in defect area after mesh suture repair, compared with a 10.1 percent increase in defect area following conventional suture repair (p < 0.0007). None (zero of 34) of the mesh sutures pulled through the surrounding tissue, whereas 65 percent (17 of 26) of the conventional sutures demonstrated complete pull-through. Excellent fibrocollagenous ingrowth was observed in 13 of 17 mesh suture specimens.

Conclusions:

Mesh sutures better resisted suture pull-through than conventional polypropylene sutures. The design elements of mesh sutures may prevent early laparotomy dehiscence by more evenly distributing distracting forces at the suture-tissue interface and permitting tissue incorporation of the suture itself. (Plast. Reconstr. Surg. 135: 322e, 2015.)


Experimental Study Characteristics of a Novel Mesh Suture

G. A. Dumanian,1 A. Tulaimat2 and Z. P. Dumanian1

1Division of Plastic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine
2Department of Medicine, Rush University Medical Center, Chicago, Illinois
USA Correspondence to: Dr G. A. Dumanian, Division of Plastic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine; 675 N. St Clair Street, Suite 19-250, Chicago, IL 60611, USA (e-mail: gdumania@nm.org)

Background:

The failure of sutures to maintain tissue in apposition is well characterized in hernia repairs. A mesh suture designed to facilitate tissue integration into and around the filaments may improve tissue hold and decrease suture pull-through.

Methods:

In vitro, the sutures were compared for resistance to pull-through in ballistics gel. In vivo, closure of midline laparotomy incisions was done with both sutures in 11 female pigs. Tissue segments were subsequently subjected to mechanical and histological testing.

Results:

The mesh suture had tensile characteristics nearly identical to those of 0-polypropylene suture. Mesh suture demonstrated greater resistance to pull-through than standard suture (mean(s.d.) 4⋅27(0⋅42) versus 2⋅23(0⋅48) N; P <0⋅001) in vitro. In pigs, the ultimate tensile strength for repaired linea alba at 8 days was higher with mesh suture (320(57) versus 160(56) N; P <0⋅001), as was the work to failure (24⋅6(14⋅2) versus 7⋅3(3⋅7) J; P <0⋅001) and elasticity (128(9) versus 72(7) N/cm; P <0⋅001) in comparison with 0-polypropylene suture. Histological examination at 8 and 90 days showed complete tissue integration of the mesh suture.

Conclusion:

The novel mesh suture structure increased the strength of early wound healing in an experimental model.

Surgical Relevance:

Traditional sutures have the significant drawback of cutting and pulling through tissues in high-tension closures. A new mesh suture design with a flexible macroporous outer wall and a hollow core allows the tissues to grow into the suture, improving early wound strength and decreasing suture pull-through. This technology may dramatically increase the reliability of high-tension closures, thereby preventing incisional hernia after laparotomy. As suture pull-through is a problem relevant to all surgical disciplines, numerous additional indications are envisioned with mesh suture formulations of different physical properties and materials.

Presented to the First World Conference on Abdominal Wall Hernia Surgery, Milan, Italy, April 2015; published in abstract form as Hernia 2015; 19: S184
Paper accepted 8 April 2015
Published online inWiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.9853