• Archives of Reconstructive Microsurgery
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• v.3 no.1
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• pp.45-53
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• 1994

Suture microvascular anastomosis is time-consuming and tedious and demands long and continuous training. Techinique of anastomosis of microvessel was presented interrupted suture and continuous suture. Recently the unilink instrument system is created as a fast and simple method to achieve high patency rates without long and continuous training in the anastomosis of small vessels. The author experimentally studied the femoral artery of 20 mice(0.5-1.0mm, av. 0.7mm), the femoral vein of 20 mice(0.8-1.6mm, av. 1.2mm) after anastomosis with interrupted suture in 20 cases and continuous sutre in 20 cases. For the unilink apparatus we used the carotid arteries of 15 cases in 14 rabbits(1.0-1.6mm, av. 1.3mm) and facial veins of 12 cases in 14 rabbits(0.9mm-2.2mm, av. 1.5mm). A total of 27 arterial and venous anastomoses were performed. We examined the postoperative patency at immediate, 2 weeks, and 8 weeks. The results were as followings, 1. In the arterial anastomosis the rate of patency was 90%(18/20) in interrupted suture, 90%(18/20) in continuous suture and 93%(13/15) in unilink apparatus. In the venous anastomosis the rate of patency was 90%(18/20) in interrupted suture, 80%(16/20) in continuous suture and 100%(9/9) in unilink apparatus. 2. The mean time for completion of the arterial anastomosis were 12.2 minutes in interrupted suture group, 10.3 minutes in continouous suture group and 8.5 minutes in unillnk apparatus group. The mean time for completion of the venous anastomosis were 13.6 minutes in interrupted suture group, 11.0 minutes in continuous suture group and 6.2 minutes in unilink apparatus group. 3. At the histological examination of suture group, hyperplastic reaction of middle layer and subintimal hyperplasia were observed. In unilink apparatus group, the endothelium layer was continued and the thickness of vessel wall was decreased due to moderate atrophy of the media and mild degree of nonspecific chronic inflammation were seen around the unilink apparatus. 4. No significants was noticied in foreign body reaction among the interrupted, continuous and unilink apparatus group. 5. A case of the arterial anastomosis was released with acting out at 15 minutes after operation. 6. The important factors in the technical problems were accurate apposition of the cut vessel edges in suture group and the proper selection of the ring size and optimal fitting between two rings in unilink apparatus group. Even though the outer diamater of vessel in suture group was different from that in unilink apparatus group the unilink method provides a very safe, fast, and simple way to perform microvascular anastomoses especially in anastomosis of vein. But howerver suture was needed in vessels below 1 mm outer diamater. In that situation continuous suture was benefit than the interrupted suture in operation time.

• Journal of Veterinary Clinics
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• v.39 no.6
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• pp.353-359
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• 2022

Several suture patterns can be used for cystotomy closure, and a continuous suture pattern is the most commonly used. In this study, the fluid-tight ability and other suitabilities of continuous appositional sutures, such as the simple continuous suture pattern (SC), running suture pattern (RN), and Ford interlocking suture pattern (FI), were compared for cystotomy closure. Cystotomy closure was performed using each suture method in 10 cases of ex vivo swine bladders in each group. Suture time, leakage site, suture length, bursting pressure (BP), bursting volume (BV), and circular bursting wall tension (CBWT) were measured. Suture time and suture length were the shortest in RN and the longest in FI. Leakage occurred in two places: the incision line directly and the hole made by the suture. Leakage occurred through the incision line in 4 bladders of the RN group and 2 bladders of the FI group, but not in the SC group, and in the rest of the bladders, leakage occurred through the suture hole. The values of BP, BV, and CBWT increased in the order of FI, SC, and RN. Suture time and suture length can be considered as factors related to healing and side effects. In this study, leakage through the incision was found in a less appositional area; therefore, leakage through the hole could be considered an indicator of better apposition. Good apposition is one of the conditions required for ideal cystotomy closure. The bursting strength representing the fluid-tight ability can be expressed as the CBWT. RN is expected to be efficient and cause a small degree of foreign body reaction; however, it is expected to be less stable. FI has the greatest fluid-tightness ability, but it has been proposed that side effects due to foreign body reactions most frequently occur in FI. In conclusion, SC, which is expected to have a sufficient degree of fluid-tightness and appropriate recovery, is preferable to other continuous appositional suturing methods for cystotomy closure.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.22-27
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• 1999

While the conventional end-to-end anastomotic technique is accepted as 'the golden standard' for microvascular anastomosis, it is time-consuming and tedious. In an effort to offer faster and safer ways of performing microvascular anastomoses, numerous anastomotic techniques have been proposed, but further refinements in microvascular techniques are still necessary. A 'continuous suture with interrupted knot' technique was devised for faster and safer anastomosis. It has been successfully used in microanastomoses of both artery and vein for free tissue transfer. It is a combination of the interrupted suturing technique and the continuous suturing technique. First, a continuous suture is made with the size of loop decreasing in order, and then the sutures are tied individually from the first loop to the last one as in the conventional interrupted suturing technique. It was applied clinically to fourteen patients over the past ten months and found to be a highly efficient technique that satisfied our needs. This 'continuous suture with interrupted knot' technique has several advantages over other techniques : The operative time is reduced comparing conventional interrupted suture technique. By delaying the tie and with the vessel walls kept separated, the risk of through-stitch can be reduced. Tying all the sutures at one time not only speed up the procedures, but also reduced the surgeon's fatigue. In addition, it has no problem of anastomotic stenosis which is a disadvantage of continuous suture technique. This technique proved to be faster and safer, and has patency equal to that of the conventional end-to-end anastomosis. It is of great help to the surgeon in reducing operative time, especially in clinical situations when many anastomoses are required, or lengthy grafting procedures are undertaken.

• Journal of Veterinary Clinics
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• v.18 no.2
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• pp.124-132
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• 2001

The purpose of this study is to know whether single layer continuous connell suture is an acceptable alternative to simple interrupted approximating suture for end-to-end intestinal anastomosis in dogs. Fourteen mixed-breed dogs weighing 2 to 5 kg were allotted to group treated with simple interrupted approximating suture (Group I) and group treated with single layer continuous Connell suture (Group II), each of 7 dogs. All dogs in each suture pattern were compared with time for total operation ad suture elapsed for intestines to anastomose, clinical signs, changing of pre-and postoperative luminal size, status of feces, adhesion at anastomotic site for 14 days after operation. Time for total operation and suture time for intestinal anastomosis were none significant between Group I and Group II, although those in Group II was about 3 minutes shorter than those in Group I, respectively. Group I spent average 47.08${\pm}$11.10 minutes on total operation, 20.97${\pm}$5.54 minutes on suture time for intestinal anastomosis and Group II spent average 44.74${\pm}$7.77 minutes, 17.73${\pm}$3.05 minutes, respectively. All dogs were no special differences in vitality, vomiting, appetite between Group I and Group II for 14 days after operation. All dogs, except one dog in Group I, had showed normal vitality and appetite since 6~8 days after operation. Initial return of fecal passage showed in all dogs before 6 days after operation and thereafter most dogs showed normal feces. According to results, it was thought that all dogs with normal vitality and appetite before 8 days had showed good prognosis. There were no changes of intestinal luminal size in 2 dogs performed Group In and one dog performed Group II between at operation and 14 days after operation. Narrowing rate of intestinal lumen in Group I was average 9.3% of the normal diameter, whereas in Group II, 9.5% of normal diameter. In complications after operation, only one dog in Group I showed intestinal intussusception but the others didn't. Length of adhesion was measured between intestinal anastomotic site and omental graft. Length of adhesion in dogs performed Group II was mostly shorter than that of Group I. Adhesion with proximate intestines occurred in five dogs, which consisted of 3 dogs performed Group I and 2 dogs performed Group II. Concurrently, they had a great length of adhesion between anastomotic site and omental graft. There were no great differences between Group I and Group II about speed of operation, clinical signs, complications such as leakage and stricture. And all dogs performed intestinal anastomosis showed good clinical condition and prognosis. In conclusion, Single layer continuous Connell suture can safely perform an intestinal anastomosis and be an alternative of simple interrupted approximating suture in aspect of speed clinically.

• Korean Journal of Bronchoesophagology
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• v.7 no.1
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• pp.9-13
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• 2001

Background： Tracheal resection and end-to-end anastomosis are the preferred treatment for tracheal tumor or tracheal stenosis. Absorbable suture material has been commonly used in case of tracheal anastomosis. But anastomosis technique is controversial. This experimental study compared between interrupted suture and continuous suture using Polydioxanone (PDS) absorbable suture material after tracheal resection and end-to-end anastomosis in rabbits. Methods : Twenty-four rabbits were used, divided into two groups of 12 animals each. The trachea was resected and then anastomosed with continuous 6-0 polydioxanone (PDS) (group 1), and intermittent 6-0 polydioxanone (PDS) (group 2). The animals were followed up for 6 months. Stenosis of the trachea was assessed at the time of death. Results : In two groups, anteroposterior diameter, transverse diameter, cross sectional area, and perimeter were greater in group 2 than in group 1 but, not significantly different. In addition, histologic findings were not different in two groups. Conclusions : This study suggest that stenosis after tracheal resection and end-to-end anastomosis using absorbable polydioxanone (PDS) suture material be not significantly different in both groups.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.237-241
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• 1986

In clinical microsurgery, limitation of space often prohibits rotation of a double clamp in an end-to-end anastomosis, or shortage of length of the secondary vessel in an end-to-side anastomosis does not allow visualization of the back wall. In these situation, back wall repair is extremely difficult. To overcome this problem, we use continuous suture technique without rotation of double clamp for end-to-end and end-to-side anastomosis of the 40 rat femoral arteries. After continuous sutures for microarterial anastomosis, the following results were obtained: Continuous sutures are useful in anastomosis where there is unavoidable limited access to the posterior wall and for some of the larger vessels now being anastomosed in free flap and other reconstructive surgery.

• Journal of Chest Surgery
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• v.27 no.3
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• pp.238-240
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• 1994

We performed post-operative hemodynamic evaluation and lung perfusion scan after left lung transplantation in dog. The heart & lungs were extracted from donor dog while the both lungs were flushed with 4oC Euro-Collin`s solution after heparinization & infusion of prostaglandin E1.In the recipient dog, anastomosis of the left atrial cuff was performed by continuous 4-0 Prolene everted suture, and bronchial anastomosis by telescope method with 4-0 Prolene continuous suture. The end-to-end anastomosis of left main pulmonary arteries was performed with continuous 6-0 Prolene suture. After closure of left thoracotomy incision, the lung perfusion scan was performed post operative 2 days for evaluation of the function of the transplanted lung which showed good perfusion. The dog was sacrificed in the post-operative 5 days for autopsy.

• Journal of Chest Surgery
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• v.45 no.1
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• pp.19-23
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• 2012

Background: A ring implantation in the tricuspid annulus requires many interrupted mattress sutures for correction of tricuspid regurgitation (TR). In this study, tricuspid ring annuloplasty was performed by 2-0 polypropylene continuous suture instead of multiple interrupted 2-0 polyester mattress sutures, and the efficacy of the method was evaluated. Materials and Methods: This study included 20 patients who underwent tricuspid ring annuloplasty by continuous suture between May 2009 and July 2010. Four of the patients had an isolated TR, and the rest had a left-sided cardiac lesion. The concomitant tricuspid annuloplasty was performed after the left-sided heart surgery was completed and a Duran flexible ring prosthesis was used. Results: There was no perioperative mortality or conduction problem. More than a moderate degree of TR was improved to less than a mild degree after the procedure. After the ring annuloplasty, the right atrial volume decreased from $123.7{\pm}69.2mL$ to $74.5{\pm}37.4mL$, and the mean right atrial pressure was lowered from $18.7{\pm}12.2mmHg$ to $8.9{\pm}5.5mmHg$. Conclusion: The continuous "over and over" suture may be a useful procedure for fixing the ring to the annulus and making an intentional annular placation in performing tricuspid ring annuloplasty.

• Journal of Chest Surgery
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• v.28 no.4
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• pp.335-339
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• 1995

Secundum atrial septal defect occupies about 10 to 15% of congenital heart diseases, and the surgical accomplishment is outstanding, so that the operative mortality is getting near to zero percent. But, the methods of correction, direct closure versus patch closure are still controversial and there is no absolute method about it. Some surgeons prefer direct closure technique for its simplicity and lesser thrombogenicity but others, afraid of arrhythmia and suture detachment after closure of large defect, prefer patch closure. Usually most surgeons use direct suture technique in small and moderate sized defects and patch closure in large defects. In our hospital, 156 cases of isolated secundum atrial septal defect were closed directly by double continuous over and over suture using 5-0 polypropylene[prolene , regardless their sizes and the amounts of shunt flow. There were no operative mortality and no serious complications such as heart block, suture detachment and embolism.

• Journal of Minimally Invasive Surgery
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• v.21 no.4
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• pp.160-167
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• 2018

Purpose: The aim of our study was to present an abdominal wall closure technique using barbed suture $V-Loc^{TM}$ 90 after single incision laparoscopic appendectomy (SILA) and to compare perioperative outcomes with conventional layer by layer abdominal wall closure after SILA. Methods: From March 2014 to July 2016, a retrospective case-control study was conducted for a total of 269 consecutive patients who underwent SILA. According to abdominal wall closure methods, 129 patients were classified into the V-Loc closure group and 140 patients were assigned into the conventional layer by layer closure group. In the V-Loc group, abdominal wall closure was performed from the fascia to the skin with a single thread of unidirectional absorbable barbed suture $V-Loc^{TM}$ 90 2-0 using continuous running suture and reverse overlapping reinforced running technique. Subcutaneous closure and subcuticular suture were performed with the remaining portion of V-Loc. Results: The V-Loc closure group showed shorter total operation time ($40.0{\pm}15.4min$ vs. $44.9{\pm}16.3min$, p=0.013) and abdominal wall cusing continuous running suture and reverse overlapping reinforced running technique. Subcutaneous closure and subcuticular suture were performed with the remaining portion of V-Loc. Results: The V-Loc closure group showed shorter total operation time losure time ($5.5{\pm}0.9min$ vs. $6.5{\pm}0.8min$, p<0.001). Postoperative incision length was significantly shorter in the V-Loc closure group ($1.1{\pm}0.3cm$ vs. $1.8{\pm}0.4cm$, p<0.001). Postoperative wound pain, time to resume diet, postoperative hospital stay, complications including surgical site infection, or mean patient satisfaction score at one month after hospital discharge was not significantly different between the two groups. Conclusion: In conclusion, unidirectional knotless barbed suture is a safe alternative method for abdominal wall closure after SILA. It can save time while providing comparable cosmesis.