title: The effect of cartilaginous reinforcing sutures on initial tracheal anastomotic strength: a cadaver study.
abstract: OBJECTIVE
  During tracheal resection with primary anastomosis, cartilaginous reinforcing sutures may be placed outside of the primary anastomosis with the goal of preventing early dehiscence. The direct effect of such reinforcing sutures on anastomotic strength has not been previously investigated. The goal of this study was to determine if the addition of cartilaginous reinforcing sutures adds to tracheal anastomosis stability.
  
  
  METHODS
  Prospective cadaver study.
  
  
  METHODS
  This research was conducted at an anatomy lab at Indiana University School of Medicine.
  
  
  METHODS
  Twelve cadaver tracheas were harvested. Each trachea was bifurcated, with 1 segment of each trachea transected and anastomosed using circumferential sutures and the remaining tracheal segment undergoing the same procedure with the addition of cartilaginous reinforcing sutures. Segments (proximal versus distal) were alternated to control for potential anatomic-based strength differences. The force necessary for anastomotic rupture was measured, and a Wilcoxon signed-rank test was used to compare means.
  
  
  RESULTS
  Analysis demonstrated the mean anastomotic rupture point for tracheas with reinforcing sutures was 297 N (95% confidence interval = 241.1-352.9), while the mean for trials without reinforcing sutures was 173 N (95% confidence interval = 142.63-203.37; P = .0054). The point of rupture occurred at the anastomosis in 1 case with reinforcing sutures and in 8 of 11 cases without reinforcing sutures.
  
  
  CONCLUSIONS
  Cartilaginous reinforcing sutures were found to provide a higher force requirement for tracheal anastomotic rupture when compared with anastomoses without these sutures. This improved stability in tracheal anastomosis may result in a decreased risk of early tracheal rupture after anastomosis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. pschilt@iupui.edu
authors.forename: Peter N
authors.initials: PN
authors.lastname: Schilt
authors.forename: Swapna
authors.initials: S
authors.lastname: Musunuru
authors.forename: Mimi
authors.initials: M
authors.lastname: Kokoska
authors.forename: Bryan
authors.initials: B
authors.lastname: McRae
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Neill
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Halum
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D002102:Cadaver; D016009:Chi-Square Distribution; D006801:Humans; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013314:Stress, Mechanical; D013536:Suture Techniques; D014132:Trachea / Q000601:surgery*