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

Abstract

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.