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Design Innovation Paper

Creating a Small Anchor to Eliminate Large Knots in Mesh and Tape Suture

[+] Author and Article Information
Jason Green

Duke University School of Medicine, 487 Medical Science Research Building 1, 203 Research Drive, Durham, NC 27710
jlg71@duke.edu

Richard Glisson

Duke University, Department of Mechanical Engineering and Material Science, P.O. Box 90300, Durham, NC 27708
r.r.glisson@duke.edu

Jane Hung

Optum, 4242 Six Forks Road, Suite 1100, Raleigh, NC 27609
jane.hung@optum.com

Mohamed Ibrahim

Duke University Medical Center, Division of Plastic, Maxillofacial, and Oral Surgery, DUMC 3181, Durham, NC 27710
mohamed.ibrahim@duke.edu

Alfredo Farjat

Duke University, Department of Biostatistics & Bioinformatics, 11028F Hock Plaza, Box 2721, Durham, NC 27710
alfredo.farjat@duke.edu

Beiyu Liu

Duke University, Department of Biostatistics & Bioinformatics, 11028B Hock Plaza, Box 2721, Durham, NC 27710
beiyu.liu@duke.edu

Ken Gall

Duke University, Department of Mechanical Engineering and Material Science, Edmund T. Pratt Jr. School of Engineering, Duke University, Box 90300 Hudson Hall, Durham, NC 27708
kag70@duke.edu

Howard Levinson

Duke University Medical Center, Division of Plastic, Maxillofacial, and Oral Surgery, Division of Surgical Sciences, Department of Surgery and Pathology, DUMC 3181, Durham, NC 27710
howard.levinson@duke.edu

1Corresponding author.

ASME doi:10.1115/1.4040186 History: Received September 06, 2017; Revised April 29, 2018

Abstract

Wide mesh or tape sutures are used to close high-tension wounds such as in hernia or tendon repair. However, wide sutures produce large knots that are susceptible to increased palpability, infection, and foreign body response. To prevent such adverse events, we developed a small suture anchor to replace wide suture knots. The suture anchor was iteratively developed using 3D design software and produced via 3D printing. Anchor prototypes underwent monotonic, cyclic fatigue, and stress-life testing in a benchtop soft tissue suture model. Results were compared to a standard of care knot and alternative suture fixation devices. The final anchor design was selected based on minimal size and mechanical performance. The size of the final anchor (200 mm3) was 33% smaller than a tape suture knot and 68% smaller than a mesh suture knot. Monotonic testing of mesh and tape suture revealed a significantly greater anchor failure load compared to knot and alternative fixations (p< 0.05). Additionally, all anchors successfully completed cyclic fatigue testing without failure while other fixations, including knot, failed to complete cyclic fatigue testing multiple times. Stress-life testing demonstrated durable anchor fixation under varying tensile stress. Failure mode analysis revealed anchor fracture and tissue failure as modes of anchor failure, each of which occurred at supraphysiologic forces. We created a small suture anchor that significantly outperforms knot and alternative suture fixations in benchtop testing and addresses concerns of increased palpability, infection, and foreign body response from large suture knots.

Copyright (c) 2018 by ASME
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