The effect of cyanoacrylate on knot elongation in three sutures used for prosthetic laryngoplasty in the horse.
Authors: Watkins Amanda R, Ford Matt, van Eps Andrew W, Stefanovski Darko, Parente Eric J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Suture elongation during cyclic loading is a critical concern in prosthetic laryngoplasty, as loss of arytenoid abduction directly compromises airway patency; this mechanical study compared how three commonly available suture materials behave under dynamic tension, specifically measuring knot slippage with and without cyanoacrylate reinforcement. Using a mechanical testing apparatus, researchers cycled square knots of 5 USP multifilament long-chain ultra-high molecular weight polyethylene (UHMWPE), 2 mm woven UHMWPE tape, and 5 USP braided polyester through 1000 repetitions from 25 to 50N, measuring total construct elongation and isolating knot-specific elongation from baseline suture creep. Polyester exhibited the highest total elongation (6.2–7.8 mm), followed by multifilament UHMWPE (3.4–6.4 mm) and woven UHMWPE tape (2–3.7 mm); however, polyester demonstrated the smallest knot elongation (1.6 mm), which decreased by a further 1 mm when cyanoacrylate was applied to the knot. For practitioners managing laryngeal hemiplegia cases, these findings suggest that whilst UHMWPE tape offers superior material stability overall, polyester supplemented with cyanoacrylate adhesive may provide the most mechanically stable knot interface, potentially reducing recurrent abduction loss and extending prosthetic durability.
Read the full abstract on PubMed
Practical Takeaways
- •When selecting suture material for prosthetic laryngoplasty, expect polyester to elongate more overall but show less knot slippage than UHMWPE alternatives—trade-offs exist between construct stability and knot security
- •Consider applying cyanoacrylate to polyester knots as a simple intraoperative step to reduce knot elongation by ~1 mm and help preserve long-term arytenoid abduction
- •UHMWPE tape appears most resistant to total construct elongation and may better maintain surgical correction over time, though knot stability requires further investigation
Key Findings
- •Polyester suture showed greatest total elongation (6.2–7.8 mm) compared to UHMWPE multifilament (3.4–6.4 mm) and UHMWPE tape (2–3.7 mm) under cyclic loading
- •Polyester demonstrated lowest knot elongation (1.6 mm) of the three materials tested
- •Cyanoacrylate application reduced polyester knot elongation by 1 mm, suggesting potential benefit for maintaining arytenoid position post-surgery