Suture Alternative in Lumbar Dural Closure Contributes to Variation in Leak Pressures: Experimental Mannequin.
Clin Backbone Surg. 2017 Jul;30(6):272-275
Authors: Ghobrial GM, Maulucci CM, Viereck MJ, Beygi S, Chitale A, Prasad S, Jallo J, Heller J, Sharan AD, Harrop JS
STUDY DESIGN: Open-label laboratory investigational research; non-animal surgical simulation.
OBJECTIVE: The authors carry out a comparability of dural closure power in a durotomy simulator throughout 2 totally different suture supplies.
SUMMARY OF BACKGROUND DATA: Incidental durotomy resulting in persistent cerebrospinal fluid leak provides appreciable morbidity to spinal procedures, usually complicating routine elective lumbar spinal procedures. Utilizing an experimental durotomy simulation, the authors evaluate the power of closure utilizing Gore-Tex with different suture varieties and sizes, utilizing varied closure methods.
METHODS: A comparability of dural closures was carried out via an evaluation of the height strain at which leakage occurred from a standardized durotomy closure in a longtime cerebrospinal fluid restore mannequin with a premade L3 laminectomy. Nurolon was in contrast with Gore-Tex sutures sizes (for Gore-Tex, CV-6/5-Zero and CV-5/Four-Zero was in contrast with Nurolon Four-Zero, 5-Zero, and 6-Zero).
RESULTS: Thirty-six trials have been carried out with Nurolon Four-Zero, 5-Zero, and 6-Zero, whereas 21 trials have been carried out for Four-Zero and 5-Zero Gore-Tex. The imply peak strain at which fluid leakage was noticed was 21 cm H2O for Nurolon and 34 cm H2O for Gore-Tex. No matter suture selection, all trials have been grouped by closure method: working suture, locked steady, and interrupted suture. No important distinction was famous between the teams. For every of the three trials teams by closure method, working, locked steady, and interrupted, Gore-Tex closures had a considerably larger peak strain to failure. Interrupted Gore-Tex was considerably larger than Interrupted Nurolon (P=Zero.007), working Gore-Tex was considerably larger than working Nurolon (P=Zero.Zero34), and locked Gore-Tex was considerably larger than locked Nurolon (P=Zero.014).
CONCLUSIONS: Durotomy closure within the lumbar backbone with Gore-Tex suture could also be an affordable choice for offering a watertight closure. On this laboratory research, Gore-Tex suture supplied watertight dural closures that withstood larger peak pressures.
PMID: 28632550 [PubMed – indexed for MEDLINE]