Suturing methods in prolapse surgery: a biomechanical analysis

Abstract Introduction Pelvic organ prolapse is a common problem in urogynecological surgery. Abdominal and laparoscopic sacrocolpopexy is currently considered to be the gold standard of treatment. The main problem remains the anatomical point of fixation as well as how sutures are placed. We evaluated the biomechanical difference between an in-line ligament suture versus an orthogonal ligament suture and a single suture versus a continuous suture at the anterior longitudinal ligament in an in-vitro, sacrocolpopexy model. Methods Biomechanical in-vitro testing was performed on human, non-embalmed, female cadaver pelvises. An Instron test frame (tensinometer) was used for load/ displacement analysis. The average patient age was 75 years. Ligament preparation yielded 15 ligaments available for testing. Recorded parameters were the ultimate load, failure displacement, and stiffness. Results This in-vitro analysis of different suturing methods showed the difference between an orthogonal and an in-line approach to be the ultimate load. Orthogonal sutures displayed an ultimate load of 80 N while in-line suturing yielded only 57 N (p < 0.05). For the anterior longitudinal ligament, this study demonstrated that continuous suture is significantly superior to a single suture regarding failure displacement (p < 0.05). Conclusion We established baseline biomechanical parameters for the sacrospinous ligament and anterior longitudinal ligament. An orthogonal suture is superior to an in-line suture in an in-vitro model. A continuous suture is superior to a single suture at the anterior longitudinal ligament. Clinical trials might be able to evaluate whether any clinical significance can be established from these findings.

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Biomechanical Analysis of Intrinsic Tendon Healing in Vitro and the Effects of Vitamins A and E

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199105000-00019 ◽

1991 ◽

Vol 87 (5) ◽

pp. 931-932

Author(s):

G??ran Lundborg

Keyword(s):

Tendon Healing ◽

Biomechanical Analysis

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Comparison of a multifilament stainless steel suture with FiberWire for flexor tendon repairs — an in vitro biomechanical study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412452074 ◽

2012 ◽

Vol 38 (4) ◽

pp. 418-423 ◽

Cited By ~ 14

Author(s):

E. McDonald ◽

J. A. Gordon ◽

J. M. Buckley ◽

L. Gordon

Keyword(s):

Mechanical Properties ◽

Stainless Steel ◽

Ultimate Load ◽

Flexor Tendon ◽

Biomechanical Study ◽

Flexor Digitorum Profundus ◽

Human Cadaver ◽

Mode Of Failure ◽

Flexor Digitorum

Our goal was to investigate and compare the mechanical properties of multifilament stainless steel suture (MFSS) and polyethylene multi-filament core FiberWire in flexor tendon repairs. Flexor digitorum profundus tendons were repaired in human cadaver hands with either a 4-strand cruciate cross-lock repair or 6-strand modified Savage repair using 4-0 and 3-0 multifilament stainless steel or FiberWire. The multifilament stainless steel repairs were as strong as those performed with FiberWire in terms of ultimate load and load at 2 mm gap. This study suggests that MFSS provides as strong a repair as FiberWire. The mode of failure of the MFSS occurred by the suture pulling through the tendon, which suggests an advantage in terms of suture strength.

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Evaluation of the bioactivity about anti-sca-1/basic fibroblast growth factor-urinary bladder matrix scaffold for pelvic reconstruction

Journal of Biomaterials Applications ◽

10.1177/0885328218811390 ◽

2018 ◽

Vol 33 (6) ◽

pp. 808-818 ◽

Cited By ~ 2

Author(s):

Jiankui Li ◽

Xi Chen ◽

Kaijian Ling ◽

Zhiqing Liang ◽

Huicheng Xu

Keyword(s):

Growth Factor ◽

Urinary Bladder ◽

Fibroblast Growth Factor ◽

Basic Fibroblast Growth Factor ◽

Pelvic Organ ◽

Fibroblast Growth ◽

Pelvic Reconstruction ◽

Urinary Bladder Matrix

Introduction and hypothesis: Pelvic support structure injury is the major cause of pelvic organ prolapse. At present, polypropylene-based filler material has been suggested as a common method to treat pelvic organ prolapse. However, it cannot functionally rehabilitate the pelvic support structure. In addition to its poor long-term efficiency, the urinary bladder matrix was the most suitable biological scaffold material for pelvic floor repair. Here, we hypothesize that anti-sca-1 monoclonal antibody and basic fibroblast growth factor were cross-linked to urinary bladder matrix to construct a two-factor bioscaffold for pelvic reconstruction. Methods Through a bispecific cross-linking reagent, sulfosuccinimidyl 4-[N-maleimidomethyl] cyclohexane-1-carboxylate (sulfo-smcc) immobilized anti-sca-1 and basic fibroblast growth factor to urinary bladder matrix. Then scanning electron microscope and plate reader were used to detect whether the anti-sca-1/basic fibroblast growth factor-urinary bladder matrix scaffold was built successfully. After that, the capacity of enriching sca-1 positive cells was measured both in vitro and in vivo. In addition, we evaluated the differentiation capacity and biocompatibility of the scaffold. Finally, western blotting was used to detect the level of fibulin-5 protein. Results The scanning electron microscope and plate reader revealed that the double-factor biological scaffold was built successfully. The scaffold could significantly enrich a large number of sca-1 positive cells both in vitro and in vivo, and obviously accelerate cells and differentiate functional tissue with good biocompatibility. Moreover, the western blotting showed that the scaffold could improve the expression of fibulin-5 protein. Conclusion The anti-sca-1/basic fibroblast growth factor-urinary bladder matrix scaffold revealed good biological properties and might serve as an ideal scaffold for pelvic reconstruction.

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Use of a simple in vitro fatigue test to assess materials used in the surgical treatment of stress urinary incontinence and pelvic organ prolapse

Neurourology and Urodynamics ◽

10.1002/nau.23823 ◽

2018 ◽

Vol 38 (1) ◽

pp. 107-115 ◽

Cited By ~ 4

Author(s):

Sabiniano Roman ◽

Naside Mangir ◽

Lucie Hympanova ◽

Christopher R. Chapple ◽

Jan Deprest ◽

...

Keyword(s):

Urinary Incontinence ◽

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Stress Urinary Incontinence ◽

Fatigue Test ◽

Pelvic Organ ◽

Materials Used

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Comprehensive Biomechanical Analysis of Three Lumbopelvic Reconstruction Techniques following Total Sacrectomy: An In Vitro Human Cadaveric Model

The Spine Journal ◽

10.1016/j.spinee.2016.07.061 ◽

2016 ◽

Vol 16 (10) ◽

pp. S161

Author(s):

Bryan W. Cunningham ◽

Mohamad Bydon ◽

Ashley A. Murgatroyd ◽

Kenneth Mullinix ◽

Ziya L. Gokaslan ◽

...

Keyword(s):

Biomechanical Analysis ◽

Total Sacrectomy ◽

Cadaveric Model

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The single-suture technique for anterior cruciate ligament graft preparation provides similar stability as a three-suture technique: a biomechanical in vitro study in a porcine model

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03350-5 ◽

2020 ◽

Vol 140 (4) ◽

pp. 511-516 ◽

Cited By ~ 1

Author(s):

Jan Theopold ◽

Stefan Schleifenbaum ◽

Alexander Georgi ◽

Michael Schmidt ◽

Ralf Henkelmann ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Porcine Model ◽

Cruciate Ligament ◽

In Vitro Study ◽

Suture Technique ◽

Vitro Study ◽

Anterior Cruciate Ligament Graft ◽

Anterior Cruciate ◽

Single Suture

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Towards Acoustic Vibration as a Diagnostic Tool for Spinal Fractures

Advances in Bioengineering ◽

10.1115/imece2005-81976 ◽

2005 ◽

Author(s):

Wafa Tawackoli ◽

Allen Burton ◽

Larry Rhines ◽

Ehud Mendel ◽

Michael Liebschner

Keyword(s):

Ultimate Load ◽

Spinal Fractures ◽

Acoustic Vibration ◽

Diagnostic Tools ◽

Promising Technique ◽

Vertebral Height ◽

X Ray ◽

Vertebral Body Fractures ◽

Shape Changes

The diagnostic tools for clinicians to detect vertebral body fractures are limited to radiation technologies1, such as X-ray and CT. The objective is to identify shape changes that reflect bone tissue failure. Because this method is subjective, only crude changes of 15% and more in vertebral height can be detected2. From in-vitro laboratory experiments it is know that the ultimate load is reached at deformations much less than 5%, and is generally detected before any shape changes are visible in radiographic images3. Acoustic vibration is a promising technique to detect changes in material integrity and quality. The overall goal of this study was to investigate the use of acoustic vibration to detect spinal fractures.

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Biomechanical analysis of the press-fit effect in a conical Morse taper implant system by using an in vitro experimental test and finite element analysis

Journal of Prosthetic Dentistry ◽

10.1016/j.prosdent.2020.10.022 ◽

2020 ◽

Author(s):

Hung-Chih Chang ◽

Chih-Han Chang ◽

Hung-Yuan Li ◽

Chau-Hsiang Wang

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Experimental Test ◽

Biomechanical Analysis ◽

Element Analysis ◽

Press Fit ◽

The Press ◽

Implant System

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FGF-2-Induced Human Amniotic Mesenchymal Stem Cells Seeded on a Human Acellular Amniotic Membrane Scaffold Accelerated Tendon-to-Bone Healing in a Rabbit Extra-Articular Model

Stem Cells International ◽

10.1155/2020/4701476 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Jun Zhang ◽

Ziming Liu ◽

Yuwan Li ◽

Qi You ◽

Jibin Yang ◽

...

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Amniotic Membrane ◽

Bone Healing ◽

Chondrogenic Differentiation ◽

Biomechanical Analysis ◽

Specific Marker ◽

Amniotic Mesenchymal Stem Cells

Background. FGF-2 (basic fibroblast growth factor) has a positive effect on the proliferation and differentiation of many kinds of MSCs. Therefore, it represents an ideal molecule to facilitate tendon-to-bone healing. Nonetheless, no studies have investigated the application of FGF-2-induced human amniotic mesenchymal stem cells (hAMSCs) to accelerate tendon-to-bone healing in vivo. Objective. The purpose of this study was to explore the effect of FGF-2 on chondrogenic differentiation of hAMSCs in vitro and the effect of FGF-2-induced hAMSCs combined with a human acellular amniotic membrane (HAAM) scaffold on tendon-to-bone healing in vivo. Methods. In vitro, hAMSCs were transfected with a lentivirus carrying the FGF-2 gene, and the potential for chondrogenic differentiation of hAMSCs induced by the FGF-2 gene was assessed using immunofluorescence and toluidine blue (TB) staining. HAAM scaffold was prepared, and hematoxylin and eosin (HE) staining and scanning electron microscopy (SEM) were used to observe the microstructure of the HAAM scaffold. hAMSCs transfected with and without FGF-2 were seeded on the HAAM scaffold at a density of 3×105 cells/well. Immunofluorescence staining of vimentin and phalloidin staining were used to confirm cell adherence and growth on the HAAM scaffold. In vivo, the rabbit extra-articular tendon-to-bone healing model was created using the right hind limb of 40 New Zealand White rabbits. Grafts mimicking tendon-to-bone interface (TBI) injury were created and subjected to treatment with the HAAM scaffold loaded with FGF-2-induced hAMSCs, HAAM scaffold loaded with hAMSCs only, HAAM scaffold, and no special treatment. Macroscopic observation, imageological analysis, histological assessment, and biomechanical analysis were conducted to evaluate tendon-to-bone healing after 3 months. Results. In vitro, cartilage-specific marker staining was positive for the FGF-2 overexpression group. The HAAM scaffold displayed a netted structure and mass extracellular matrix structure. hAMSCs or hAMSCs transfected with FGF-2 survived on the HAAM scaffold and grew well. In vivo, the group treated with HAAM scaffold loaded with FGF-2-induced hAMSCs had the narrowest bone tunnel after three months as compared with other groups. In addition, macroscopic and histological scores were higher for this group than for the other groups, along with the best mechanical strength. Conclusion. hAMSCs transfected with FGF-2 combined with the HAAM scaffold could accelerate tendon-to-bone healing in a rabbit extra-articular model.

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