Biomechanical comparison of six suture configurations using a large diameter polyester prosthesis in the muscular process of the equine arytenoid cartilage.
Authors: Kelly Jenny R, Carmalt James, Hendrick Steven, Wilson David G, Shoemaker Ryan
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Suture Configuration for Arytenoid Cartilage Prosthesis in Equine Laryngeal Surgery Laryngeal hemiplegia remains a significant performance-limiting condition in horses, and surgical stabilisation techniques continue to evolve to improve longevity and reduce complications. Kelly and colleagues biomechanically evaluated six different suture patterns (four single-suture and two double-suture configurations) used to secure a large-diameter polyester prosthesis to the muscular process of the arytenoid cartilage in 121 cadaveric equine larynges, testing each construct to failure under progressive distraction at 100 mm/min. Double-suture patterns demonstrated significantly greater failure force at both the construct level and the cricoarytenoid joint itself compared to single-suture patterns, though energy absorption at failure showed no meaningful difference between configurations. Critically, three of the four single-suture patterns failed primarily at the muscular process itself (≥50% of failures), whilst the superior patterns—those engaging the spine of the muscular process—shifted failure modes towards the clamp or cricoid cartilage, suggesting improved construct integrity. For practitioners, these findings indicate that suture techniques which adequately engage the muscular process spine, particularly when reinforced with a second suture, provide biomechanically superior results and may enhance the durability of laryngeal prosthesis placement in clinical cases.
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Practical Takeaways
- •When performing arytenoid prosthesis placement, prioritise double suture patterns over single patterns for improved construct stability and resistance to failure
- •Ensure sutures engage the spine of the muscular process, as this anatomical engagement provides superior biomechanical strength compared to alternative positioning
- •Design surgical approach to minimise muscular process failure, which is the most common failure mode in poorly configured single suture patterns
Key Findings
- •Double suture patterns demonstrated significantly greater construct and cricoarytenoid joint failure force compared to single suture patterns (P<0.05)
- •Sutures engaging the spine of the muscular process were biomechanically superior to those not engaging this anatomical landmark
- •Failure at the muscular process accounted for ≥50% of construct failures in 3 of 4 single suture patterns tested
- •No significant differences in energy stored at construct failure between suture configurations