Dobrin P B, Gosselin C, Kang S, Mrkvicka R
Department of Surgery, Loyola University Medical Center, Hines, Ill., USA.
J Vasc Surg. 1997 Dec;26(6):1029-35. doi: 10.1016/s0741-5214(97)70016-8.
Most studies of sutures used in vascular surgery have used steadily applied loads. But in vivo, sutures are subject to pulsatile pressures. Pulsatile pressures could weaken sutures, or they could be beneficial by helping to slide the suture, thereby equilibrating the tension between unevenly tightened loops. This study examined the effect of pulsatile pressures on the strength and movement of polypropylene (Prolene) sutures.
Segments of pig thoracic aorta were cannulated and studied in a tissue bath in vitro at 37 degrees C. A longitudinal arteriotomy was made and then closed with running 6-0 Prolene. Vessels were subjected to (1) no pressure; (2) 100 mm Hg steady pressure; or (3) 112/65 mm Hg pulsatile pressure. After 48 hours the sutures were studied for breaking strength. In a second, separate set of experiments, longitudinal arteriotomies were closed using running suture lines. These were constructed with either several loose loops or several overly tight loops. Fine wires were affixed to the suture loops to permit photographic recording of suture movement.
There was no difference in breaking force among 68 sutures that had been subjected to (1) no pressure; (2) 100 mm Hg steady pressure; or (3) 112/65 mm Hg pulsatile pressure. These also were no different than sutures that were not sewn into arteries. These findings indicate that neither steady nor pulsatile pressures weaken Prolene sutures. In the second set of experiments, it was found that pulsatile pressure did cause movement of suture lines where there were loose loops (p < 0.05). However, neither steady nor pulsatile pressures caused movement of loops in suture lines that contained normal and overly tight loops.
Neither steady nor pulsatile physiologic pressures weaken 6-0 Prolene sutures that have been used to close a longitudinal arteriotomy. These pressures can cause movement of loose suture lines, but do not equilibrate the tension between normal and overly tight suture loops. Overly tight loops may place excessive load on a suture line.
