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KMID : 0350519930460010211
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Journal of Catholic Medical College
1993 Volume.46 No. 1 p.211 ~ p.222
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Influence of Suture Materials on Growth and Stricture of Traccheal Anaastomosis in Growing Rabbits.
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Abstract
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Aprimary tracheal resection and end-to-end anastomosis is considered to be the most dependable and efficient way of regaining anatomic and functional continuity of trachea in the patients with tracheal lesions.
In infants and young chidren, operative success of tracheal reconstruction does not complete until the patients have reached essentially full growth and have an effectively normal airway.
The development of stenosis at the suture line after tracheal resection and end-to-end anastomosis of the trachea are associated with inadequate anatomic mobiliation, unskilled anastomotic technique and choice of inadequate sture materials.
According to these suture materials, high incidence of stenosis or granuloma at the suture line may be developed when the children grow up. We compared the influence of synthetic nonabsorbable(polypropylene, Prolene(r)) with absorbable(polyglactin 910, Coated Vicryl(r) and polydioxanone, PDS(r)) suture materials and synthetis absorbable multifilament(Coated Vicryl(r)) with monofilament(PDS(r)))) suture material.
To evaluate the stenosis and growth of anastomosis sites after complete transection and end to end anastomosis with full thickness bites using various suture materials, three groups of 2-monthold rabbits (weighting about 1.7±0.15kg, n=36) were studied.
Under the general anesthesia without intubation, the trachea was transected at the 5th cartilage ring and then anastomosed with simple interrupted 6-0 Prolene (group I, n=12), 6-0 Coated Vicry(groupⅡ, n=12) and 6-0 PDS(groupⅢ, n=12). The rabbits were
electively killed after 105 to 113 days(menan follow up, 108 days) for tracheal measurement. Internal diameters of trachea in the lateral and anteroposterior planes were measured at the site of anastomosis ( I ) at the time of inital anastomosis.
Also, internal diameters were measured from the excised tracheal specimens of killed animals at the site of the anastomosis(A). And then average normal values(N) were obtained from two ring above and below each anastomosis at the time of death and
served as its own control. And the cross sectional areas(CSA) and the mean percent growth rate of the anastomotic sites(% A/N) were calculated. The tracheal segments were examined for comparing histologic findings in each group.
@ES The results obtained were as follows :
@EN 1. During the follow up period, thre was a 197% increase in body weight to 3.3±0.18kg and nosignificant difference in growth of body weight among the groups.
2. The growth of the lateral diameters was significantly less than anteroposterior diameters in each group(groupⅠ; 80±5%, 83±4%, groupⅡ; 86±3%, 90±4%, groupⅢ; 89±4%, 94±3%) (P<0.05).
3. In a comparison of nonabsorbale versus absorbable suture materials (groupⅠversus groupⅡand groupⅢ) at the time of death of the animals, the growth of the both internal diameters and the cross sectional areas in group Ⅰwas significantly less than
those of other groups(P<0.05).
4. In a comparisin of these two absorbable suture materials(groupⅡveruss groupⅢ), the growth of the both internal diameters and the cross sectional areas at the time of death of the animals in groupⅢ were significantly greater than that in groupⅡ(P<0.05).
5. Histologic analysis showed that severe subepithelial fibrosis protruding into lumen at anastomotic sites and intense inflammatory reaction and fibrosis around nonabsorbed Prolene sutures in groupⅠwere nore frequent than in other two groups.
It was revealed that inflammatory reaction of anastomotic sites in groupⅡwas more intense than that of groupⅢ. And, completely absorbed Coated Vicryl sutures were replaced by a fibrous tissue, mononuclear chronic inflammatory cells and foreign
body-laden histiocytes in groupⅡ, but fibrosis was little seen surrounding PDS sutures with partial degradation.
In conclusion, although there was little evidence of respiratory impairment, the transection of the trachea with end to end anastomosis result in stenosis and retardation of growth at the anastomosis site in growing rabbits, especially, in lateral dimension of tracheal anastomosis.
The nonabsorbable suture material(Prolene) induced more remarkable stenosis of anastomoses than the absorbable suture marterials(Coated Vicryl and PDS). And the degree of stenosis was significantly less when monofilament absorbable suture (PDS)
was used.
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