ISSN: 0022-1198
CODEN: JFSCA
Published Online: 1 September 2004
Page Count: 5

Postmortem Analysis of Anastomotic Suture Line Disruption Following Carotid Endarterectomy
Melinek, J
Office of Medical Examiner-Coroner, CA

Moalli, J
Exponent, Failure Analysis Associates, CA

Lento, P
Mount Sinai Medical Center, NY

(Received 21 June 2003; accepted 10 April 2004)

Abstract

The tensile strength of a surgical suture is essential in maintaining the integrity of vascular anastomoses. While faulty operative technique and the loading strength of individual sutures have been implicated in spontaneous suture line disruptions, there has, to date, never been a published postmortem analysis of a suture that has known to have failed. We present the case of suture line disruption leading to fatal exsanguination in a 77-year-old man following carotid endarterectomy with a facial vein patch. Using both dissecting and scanning electron microscopy, we determined that surgical technique (an untied knot) was the cause of the suture line disruption. The removal of a broken or untied suture at surgery or at autopsy should not preclude proper analysis of the failed suture, because the results can have both medico-legal and public health implications.

Keywords:
forensic science, forensic pathology, suture, polypropylene, carotid endarterectomy, anastomosis, postmortem, autopsy

Paper ID: JFS2003218
DOI: 10.1520/JFS2003218
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