Suture techniques

The pursestring suture has long been recommended to seal periprosthetic leaks from a dilated atrophic shunt. The suture was applied around the prosthesis and then pulled tight. The suture can be applied after removal of the prosthesis or with the prosthesis in the shunt. However, it is not always easy, and whether or not a stable pursestring suture can be inserted depends on the size of the tracheostoma and the thickness of the shunt. In 2008 Jakobs et al. published their results of 20 cases in which they had applied a pursestring suture, and reported a success rate of 80%. In many cases, the suture had to be applied under general anesthesia, which increases costs considerably and is unpleasant – and risky – for the patient. The success rate also refers largely to the short-term seal. There is no information on the long-term success.

In cases with a wide tracheostoma, if the pursestring suture could be applied under local anesthesia, we attempted to use it to treat periprosthetic leakage. The results were disappointing. Although the seal was initially good, further leakages invariably occurred after a few days.

SUMMARY: We do not recommend the pursestring suture for the treatment of periprosthetic leakages, as more effective and safer treatment alternatives do exist. If a general anesthesia is required for insertion of the pursestring suture, then the costs and risks are disproportionally high.