Suture techniques and patch materials using an in-vitro model for watertight closure of in-utero spina bifida repair
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Read the article on jpedsurg.org ↗Article · Jun 2019 · 1 min read
In brief
In brief
In-vitro study evaluating surgical closure techniques for in-utero spina bifida repair using a chicken thigh model to simulate fetal tissue under physiologic CSF pressures. Findings demonstrate minimal wound edge traction optimizes primary closures while locking sutures provide superior watertight seal for patch-based repairs, offering technical guidance to reduce postoperative CSF leakage and Chiari II malformation rates.
Written by the GCMD Library team from the article.
Purpose
Despite proven benefits of in-utero spina bifida (SB) repair, ≥30% of children at birth have Chiari II malformation or cerebrospinal fluid (CSF) leakage from the repair site. Our study's purpose was to determine CSF pressures in the myelomeningocele sac during mid-gestation in order to design an in-vitro model for evaluating different surgical methods used for watertight closure during in-utero SB repair.
Methods
CSF pressures were measured during in-utero SB repair at mid-gestation. An in-vitro chicken thigh model, simulating fetal tissue, tested watertight closure when attached to the base of a water column. Primary closure methods were evaluated using defect sizes of 20 × 3 mm for minimal traction or 20 × 8 mm for moderate traction. Additionally, 3 common in-utero repair patches were compared using 15 × 15 mm defects.
Results
Using 6–12.5 cm pre-determined CSF pressures, 165 in-vitro experiments were performed. Regardless of methodology we found that in 66 primary-based closures that minimal versus moderate wound edge traction provided better seals. The locking method was superior to the non-locking technique for watertight closure in 99 patch-based closures.
Conclusions
Minimal wound edge traction was best for primary closures, and locking sutures ideal for patch-based closures, however surgical techniques should be individualized to improve upon clinical outcomes.