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New technology applications: Knotless barbed suture for tracheal resection anastomosis

Authors

  • Carrie M. Bush MD,

    1. Department of Otolaryngology and Center for Voice, Airway, and Swallowing Disorders , Georgia Health Sciences University, Augusta, Georgia, U.S.A.
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  • John D. Prosser MD,

    1. Department of Otolaryngology and Center for Voice, Airway, and Swallowing Disorders , Georgia Health Sciences University, Augusta, Georgia, U.S.A.
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  • Michele P. Morrison MD,

    1. Department of Otolaryngology and Center for Voice, Airway, and Swallowing Disorders , Georgia Health Sciences University, Augusta, Georgia, U.S.A.
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  • Guri Sandhu MD,

    1. Department of Otorhinolaryngology, Royal National Throat Nose and Ear Hospital, London, United Kingdom
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  • Karl H. Wenger PhD,

    1. Department of Oral Biology, College of Dentistry , Georgia Health Sciences University, Augusta, Georgia, U.S.A.
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  • David H. Pashley DMD, PhD,

    1. Department of Oral Biology, College of Dentistry , Georgia Health Sciences University, Augusta, Georgia, U.S.A.
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  • Martin A. Birchall MD,

    1. Department of Otorhinolaryngology, Royal National Throat Nose and Ear Hospital, London, United Kingdom
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  • Gregory N. Postma MD,

    1. Department of Otolaryngology and Center for Voice, Airway, and Swallowing Disorders , Georgia Health Sciences University, Augusta, Georgia, U.S.A.
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  • Paul M. Weinberger MD

    Corresponding author
    1. Department of Otolaryngology and Center for Voice, Airway, and Swallowing Disorders , Georgia Health Sciences University, Augusta, Georgia, U.S.A.
    2. Department of Otorhinolaryngology, Royal National Throat Nose and Ear Hospital, London, United Kingdom
    • MD, Center for Voice, Airway, and Swallowing Disorders, Department of Otolaryngology, Georgia Health Sciences University, 1120 15th Street—BP4109, Augusta, GA 30912
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  • This study was internally funded by the Department of Otolaryngology and Center for Voice, Airway, and Swallowing Disorders at Georgia Health Sciences University, Augusta, Georgia. Covidien Inc. provided V-loc wound closure devices for this study, but did not have access to data acquisition, analysis, or manuscript preparation.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Tracheal resection anastomoses are often under tension and can be technically challenging. New suture materials such as V-loc (barbed, knotless wound closure device) may offer advantages over conventional methods. The objective of this study is to determine if a running V-loc suture is of comparable tensile strength to conventional closure.

Study Design:

Laboratory based study of human cadaveric tissue.

Methods:

Fresh human cadaveric tracheas were dissected and incised into segments. Anastomosis of adjacent segments was then performed with either submucosal interrupted 3-0 Vicryl, or a running submucosal 3-0 V-loc suture. Anastomosed specimens were stretched to failure on an Instron force tension machine. Surgeon satisfaction was recorded by visual analog scale (VAS).

Results:

The tensile strength of 12 tracheal anastomoses was tested. Video documentation of V-loc suture technique and anastomosis failure was recorded. In both Vicryl (80%) and V-loc (100%) anastomoses, failure occurred at the membranous intercartilaginous region. In 20% of the Vicryl anastomoses, the suture was noted to break prior to tissue failure. Anastomoses with V-loc suture had equivalent failure force (mean, 59 N) compared to interrupted Vicryl (51 N), with P = .57. On VAS, surgeons were more satisfied with V-loc suture closure compared to interrupted Vicryl closure (paired t test, P = .003).

Conclusions:

Tracheal anastomosis with running v-loc suture is a feasible alternative to conventional closure with interrupted Vicryl suture. V-loc suture provided a surgical advantage by improved ease of use.

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