A Comparison of Synthetic Absorbable Suture with Synthetic Nonabsorbable Suture for Construction of Tracheal Anastomoses

EXPERIMENTAL A Comparison Suture

with

of Synthetic Synthetic

for Construction CAPT LCDR

Nonabsorbable

of Tracheal

James A. Gibbons, MC, USN, F.C.C.P.; Reginald L. Peniston, MC, USN; MAJ

MAJ Sheldon S. Diamond, CAPT Benjamin L. Aaron,

study compares the suture (SAS, Vicryl) with able suture (SNS, Ticron) tracheal anastomoses in the underwent resection of one This

Absorbable

VC,

USAF;

MC,

use that

Anastomoses* Charles

synthetic

absorbable

(

to the suture. This the use of synthetic

study was absorbable

initiated suture

VC,

USA;

F.C.C.P.

in

Twenty-six

SAS.

of synthetic nonabsorbfor construction of cervical dog. Fourteen mongrel dogs to four tracheal rings. Paired tracheal anastomoses were constructed, using 10 SAS or 10 SNS. After two months each anastomosis was removed and analyzed. All animals survived with intact anastomoses. There were no visible reactions to the

losure or repair of the tracheobronchial ing nonabsorbable suture results but significant incidence of inflammatory

P. Raflo,

and

USN/Retired,

of

Suture

tree usa variable reactions

granulations.

en

of

Significant

and

SAS

in four revealed

in the

specimens,

SAS

spectrum

of

related

in

dogs

graded

dogs (weighing 9 to 31 kg; average, 20.5 kg) underwent cervical tracheal ring resection and anastomosis. Two dogs had the fourth ring resected, and four dogs each had fourth to fifth, fourth to sixth, or fourth to seventh rings removed. Paired tracheal anastomoses were constructed using synthetic absorbable suture (SAS, Polyglactin 910 or Vicryl) or synthetic nonabsorbable suture (SNS, silicone-treated polyester or Ticron). Ten interrupted size 3-0 sutures were used for each anastomosis. Sutures were placed trachea knots

to

the

divided

or through the membranous trachea were tied on the exterior of the trachea.

ends

posteriorly.

of

reaction demonstrated a

SNS

that

gross

directly

cor-

appearance.

the continued evaluation tracheobronchoplastic

These

for the use procedures.

of

RESULTS

mongrel

adjacent

the

the

Histologic

inflammatory

response

with

gross suture in one of sev-

Two months after surgery the dogs were killed, and the anastomoses were excised and evaluated for integrity, degree of luminal stenosis, granuloma formation, and histologic response.

All

cartilages

while

to evaluate for tracheal

METHODS

the

residual

inflammatory

survived

the The

Department of Cardiothoracic Surgery and the Investigation Center, Naval Regional Medical Center, San Diego, Calif. The opinions or assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the Navy Department. Reprint requests: Captain Gibbons, Naval Regional Medical Center, San Diego 92134

with

of

development

through

no

intensity

findings support SAS in clinical

anastomoses.

Fourteen

SNS developed stenosis developed of seven SNS anastomoses.

examination

70

into

five

web;

and

3,

Table

1 shows

seven

SNS

and that

the

None

suture cent)

rings

one

developed

quantifies Table

#{176}Fromthe

stenosis;

stenosis SAS

to

obstruction.

SAS

and

four

of

of i( or more

of

number any

of 70

suture

SNS

granulomata.

inflammatory

1-Development

the

of the specicorrelation of

demonstrated

Twenty-six

The arbitrarily posterior

area

of seven

lumen. Analysis any significant

gross

the

no

compromise

of

resected. of the 70

or reaction.

was

% luminal

developed

development

anastomoses.

stenosis

categories:

li,

the area of the tracheal mens did not disclose cheal

intact

luminal

o/

of traresidual (37

per-

Table

response

to

Luminal

Stenosis

the

2

SNS.

Clinical

340

Suture

0

Web

1/4

SAS

3

3

1

SNS

1

2

2

GIBBONS El AL

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1/2

3/4

1

1

CHEST, 79: 3, MARCH, 1981

Table Extent

2-Inflammatory

of Granulation

Not

visible,

Visible,

no

G

G G

Figure

1 illustrates

to SNS

and

The

assessment

suture

reaction

a posterior

of

27

15/70

21

in uniformity for comparable

11/70

16

inflammatory

reaction

the at

with

the

developed

from

and

from

When

the

directly

the

examination.

placethe

sutures

of

inin in-

DIscussIoN A sampling choplastic

of papers

sorbable

sutures,

linen, Tevdek, incidence of ports patients

describing did not

granuloma.’1 chromic

describing

procedures

using including

and suture

96 tracheobron-

a variety Ticron,

These

nonab-

Mersilene,

silk,

Dacron, disclosed a 14 percent granulation formation.’5 Re-

the use of chromic mention any complications

(absorbable)

of

articles suture

suggest for

suture that

line

granulations This

the

use

of

the

sutures.

problems.

reports

the

last

we

have using

use

describ-

common use

he

of this

favorable the

at the

performed SAS for serial

Naval

reported

of synthetic surgery

Regional

(perMedical

two upper-lobe sleeve the bronchial reconstruc-

Follow-up

months reveals excellent no residual inflammatory

The results of this limited but favorable continued investigation

com-

experience, use

in tracheobronchial June 26, 1979). year

of su-

of a variety

contrast,

to evaluate

eight with

suture

most the

In

tion.

sorbable

is pre-

for tracheal repair in a recent resulted in no suture granula-

Because

is continuing

Over

It

enhance the tracheobronchial

few

followed

that the use of Vicryl group of 20 patients

Center, resections

strength reten-

will for

are

to be

problem

of nonabsorbable

tion

tensile strength

reaction.’2-16

there

re-

suture

review of his experience with repair tracheal injuries, Grillo’8 found

bronchoscopy

laboratory clinical and

over anastomotic response

study experience use of

for tracheobronchial

in 73 of suture

tracheobronchial

tissue

are

use.4’17

absorbable suture sonal communication,

acute

correlated

diminished

although

such

sutures to chromic

of absorption, knot security,

procedures,

Grillo

demonstrated

a spectrum

that

of rate size,

forma-

sutures.

absorbable

these advantages absorbable suture

plication. pos-

the

and

of granuloma

superiority

sumed that of synthetic

ture

cells.

distance

resulted. of the SNS

response gross

specimens.

that

synthetic

In a recent postintubation

suture

SAS

resulted

pleat

anasto-

a thickened

excessive

newer

rate

of nonabsorbable

to demonstrate

tion,

inflammatory

trachea.

fibers

excised

residual

no

webs an

a redundant examination suture

the

revealed with

membranous

flammatory tensity

19/70

of

web

that

were tied, Histologic residual

ported

specimens

wall

sutures

of the

any SAS

tracheal

It is believed edge

the

membranous

ment

36

microscopic

in

through

terior

25/70

The

in a lower

a variety

%

of

no

results

than

ing

demonstrated

Sections

gross

tion

SAS.

histologic

moses or

the

surgery

to SNS

No.

(G)

no C

Moderate Severe

Response

a period

of

healing or stenosis.

coupled support synthetic

with the ab-

surgery.

REFERENCES

1 Crib carina

HC,

Bendixen HH, Cephart trachea. Ann Surg

and lower

FIGUBE

1. Appearance

T.

1963;

of the

Resection

of the

158:889-93

excised

anasto-

moses.

CHEST, 79: 3, MARCH, 1981

COMPARISON OF SYNTHETIC SUTURES

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341

2 Boyd resection

treatment 3

4

5

6

7

8

9

AD, and

Spencer FC, anastomosis

of bronchial

Lind been

adenoma?

A. Why has bronchial reported infrequently for

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Surg

Cardiovasc

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I

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CHEST, 79: 3, MARCH, 1981