Biomechanical comparison of six suture configurations using a large diameter polyester prosthesis in the muscular process of the equine arytenoid cartilage.

OBJECTIVE

To compare biomechanical properties of 6 suture configurations using a large diameter polyester prosthesis in the muscular process (MP) of the arytenoid cartilage and to determine failure mode.

STUDY

DESIGN

Experimental study.

SAMPLE POPULATION: Cadaveric equine larynges (n=121).

METHODS

Suture configurations (4 single, 2 double) were inserted, and then constructs were tested in a single-cycle to failure at a 100 mm/min distraction. Load deformation curves were generated to assess the biomechanical properties of each construct. A 1-way ANOVA was used to compare the mean differences in construct failure force, cricoarytenoid joint (CAJ) disarticulation force, and energy stored at failure. A 2-sample t-test was used to compare single versus double suture patterns and a Fisher's exact test was used to compare failure mode.

RESULTS

Both construct and CAJ failure force were significantly greater (P<.05) for double suture patterns compared with single suture patterns; however, there were no significant differences in energy stored at construct failure. Failure at the MP accounted for >or=50% of construct failures for 3 of the single suture patterns and 1 of the double suture patterns tested. The remaining 2 patterns had an increased frequency of clamp failures as well as failure of the cricoid cartilage.

CONCLUSIONS

Sutures that sufficiently engage the spine of the MP alone or in conjunction with a second suture were found to be biomechanically superior.

CLINICAL RELEVANCE: Engaging the spine of the MP appears to result in the most biomechanically sound laryngeal construct.