Acid Sutures Research Articles

Acupoint catgut embedding advantage in treating gastro-oesophageal reflux disease (ACE-GERD): study protocol for a randomised controlled trial

BackgroundGastro-oesophageal reflux disease (GERD) is a highly prevalent disorder worldwide and developing effective treatment strategies for GERD is a clinical priority. GERD is associated with anxiety and depression. Several approaches...

Preventing Staphylococci Surgical Site Infections with a Nitric Oxide-Releasing Poly(lactic acid-co-glycolic acid) Suture Material.

Of the 27 million surgeries performed in the United States each year, a reported 2.6% result in a surgical site infection (SSI), and Staphylococci species are commonly the culprit. Alternative therapies, such as nitric oxide (NO)-releasing biomaterials, are being developed to address this issue. NO is a potent antimicrobial agent with several modes of action, including oxidative and nitrosative damage, disruption of bacterial membranes, and dispersion of biofilms. For targeted antibacterial effects, NO is delivered by exogenous donor molecules, like S-nitroso-N-acetylpenicillamine (SNAP). Herein, the impregnation of SNAP into poly(lactic-co-glycolic acid) (PLGA) for SSI prevention is reported for the first time. The NO-releasing PLGA copolymer is fabricated and characterized by donor molecule loading, leaching, and the amount remaining after ethylene oxide sterilization. The swelling ratio, water uptake, static water contact angle, and tensile strength are also investigated. Furthermore, its cytocompatibility is tested against 3T3 mouse fibroblast cells, and its antimicrobial efficacy is assessed against multiple Staphylococci strains. Overall, the NO-releasing PLGA copolymer holds promise as a suture material for eradicating surgical site infections caused by Staphylococci strains. SNAP impregnation affords robust antibacterial properties while maintaining the cytocompatibility and mechanical integrity.

An in vitro study for the evaluation of morphological and biochemical characteristics of absorbable sutures coated with genistein and nicotine

Introduction and aim. Inflammation, cell proliferation, matrix deposition, and tissue remodeling are all elements of the well-structured and well-coordinated process of wound repair. The aim of this study was to analyze the effect of genistein and nicotine on polyglycolic acid (PGA) and vicryl sutures. Material and methods. Genistein and nicotine were isolated and solution was prepared and the suture material PGA and vicryl were immersed in the solution and dried. They were tested for their tensile strength and degradation values after immersion in artificial saliva (on the first day and on the 14th day). The sutures were also seen under a scanning electron microscope (SEM) for its uniform coating and the mixture formulation of genistein and nicotine were tested for their anti-inflammatory and antioxidant activity using protein denaturation assay and 2,2-diphenyl-1-picrylhydrazyl assay respectively. Results. Nicotine has a high anti-inflammatory activity on the suture material, whereas Genistein has an insignificant anti-inflammatory effect. The mixture formulation has a relatively similar anti-inflammatory effect when compared to the control. The SEM analysis shows a uniform coating of the formulation on the PGA and vicryl sutures. In comparison, PGA has shown lesser tensile strength and hence higher degradation ability. Conclusion. Nicotine and Genistein affect the tensile strength and degradation properties of the sutures.

Clinical Equivalence of Polyglycolic Acid Suture and Polyglactin 910 Suture for Subcutaneous Tissue Closure After Cesarean Delivery: A Single-Blind Randomized Study.

The global rise in frequency of cesarean delivery raises the concern to minimize the post-operative complications, in order to improve the maternal and neonatal health. Closure of subcutaneous tissue following cesarean section closes dead space, hence reduces the wound complications. No previous study has compared the clinical equivalence of polyglycolic acid suture with polyglactin 910 suture for subcutaneous tissue closure following cesarean section. Therefore, this study compared the incidence of subcutaneous abdominal wound disruptions within the first 6 weeks of subcutaneous tissue closure with either of the sutures. A single-blind, prospective, randomized study was conducted in two centres between February and November, 2021. Primiparous or multiparous women (18-40 years) with a singleton pregnancy requiring cesarean section were randomized to polyglycolic acid suture (Truglyde®) (n=54) and polyglactin 910 suture (Vicryl®) (n=54) group. The primary endpoint, incidence of subcutaneous abdominal wound disruptions within 6 weeks of cesarean delivery was evaluated. In addition, the secondary endpoints, incidence of post-operative subcutaneous abdominal wound disruptions for the study period, skin disruption, surgical site infection (SSI), seroma, hematoma, intraoperative handling, operative time, hospital stay, suture removal, microbial deposits on sutures, pain, time taken to resume normal activities, and adverse events were recorded. Non-significant difference in the incidence of subcutaneous abdominal wound disruptions, skin disruption, SSI, seroma, hematoma, intraoperative handling characteristics, operative time, pain, duration of hospital stay, suture removal, microbial deposits, time taken to return to day-to-day activities, and adverse events were observed between the two treatment groups. Following cesarean section, subcutaneous tissue closure using polyglycolic acid suture or polyglactin 910 suture was not associated with incidence of subcutaneous abdominal wound disruptions. Additionally, non-significant differences regarding secondary endpoints between the groups suggested the clinical equivalence of the sutures. CTRI/2020/12/029737; Registration date: 11/12/2020.

Oral post-surgical healing with polyglycolic acid suture

Objective: To improve oral post-surgical cycatrization with the use of resorbable polyglycolic acid (PGA) suture in patients undergoing dental implant surgery, by clinical assessment of signs of infection at 8, 15 and 30 days post-surgery. Method: Prospective analytical clinical research in patients of the Dental Implantology Clinic of the UniCIEO University Foundation, who underwent dental implant surgery and/or site adaptation for the placement of future implants (alveoli preservation, maxillary sinus graft and exodontics) and with the useof PGA 3.0s and 4.0s suture. They were carried out clinical controls at 8, 15 and 30 days post-surgery to evaluate the presence of pain, edema, flushing, tissue confrontation and loss of stitches. Results: Total of the sample 19 patients (26 procedures), 13 women and 6 men with average age of 60.05 years, total of implants placed 57, with guided bone regeneration 8 patients, graft in maxillary sinus 6 patients and exodontics 3 patients. The symptoms of pain, edema and flushing were decreasing from 8 days after surgery to disappear at 30 days, with a significant difference (Chi square p = 0.012). Conclusion: The use of resorbable polyglycolic acid (PGA) suture in oral implantology procedures presents a good healing process and the minimum biological complications disappeared after 30 days post-surgery.

Impact of Fluoridated Mouthwashes on Strength and Durability of Three Different Synthetic Absorbable Suturing Materials: An In Vitro Study

The aim of the current in vitro research was to assess the effect of fluoride-containing mouthwashes on the strength and durability of three different synthetic absorbable suturing materials. Three types of synthetic absorbable suture materials were employed in this research, and every group comprised 20 suture samples. These include group I: Polyglactin 910, group II: Polyglycolic acid, and group III: Poliglecaprone 25. This research utilized 4-0 gauge sutures. Each example was tied using a square surgeon's knot about elastic rubber tubing. The biology of the oral milieu was replicated in vitro through the use of artificial saliva. The medium that was subjected to test prior to inclusion were 0.2% chlorhexidine gluconate as well as 0.044% sodium fluoride. The tensile strength of the specimen suture materials was subjected to test at a particular time intervals: prior to immersion, the 1st day, the 7th day, as well as the 14th day after immersion. Tensile strength was evaluated using a Universal Ultra Test machine. Post-immersion in 0.2% chlorhexidine gluconate mouthrinse, the mean tensile strength of polyglactin (PLG) 910 sutures was 24.48 ± 0.08 at pre-immersion and 4.36 ± 0.01 on the 14th day. The mean tensile strength of polyglycolic acid (PGA) sutures was 24.04 ± 0.26 at pre-immersion and 2.10 ± 0.02 on the 14th day. The mean tensile strength of Poliglecaprone 25 sutures was 23.82 ± 0.11 at pre-immersion and 1.34 ± 0.08 on the 14th day. Post-immersion in 0.044% sodium fluoride mouthrinse, the mean tensile strength of PLG 910 sutures was 24.18 ± 0.02 at pre-immersion and 5.12 ± 0.21 on the 14th day. The mean tensile strength of PGA sutures was 24.88 ± 0.34 at pre-immersion and 4.58 ± 0.10 on the 14th day. The mean tensile strength of Poliglecaprone 25 sutures was 24.48 ± 0.27 at pre-immersion and 5.08 ± 0.14 on the 14th day. A statistically noteworthy difference was noted amid the three types of sutures at dissimilar time points evaluated with p <0.001. The current research arrived at a conclusion that there is a significant difference between the mean tensile strength and purpose of the medium used for immersion as well as the tenure. Polyglactin suture material exhibited superior strength as compared to PGA and poliglecaprone suture substances following immersion in the investigational media. Suture materials are employed in the closure of incised flaps, to aid healing by primary intention, along with control of bleeding. In oral as well as periodontal surgery, the right choice of sutures is very important for good healing. Suture choice for the mouth should be influenced by the requirements of the anticipated repair and the surgeon's fondness.

Comparison of chlorhexidine coated polyglycolic acid sutures with silk sutures during third molar surgery

Aim: The purpose of this study was to compare chlorhexidine coated polyglycolic acid sutures with silk sutures during third molar surgery. Materials And Methods: The study design was a double-blinded randomized control trial. Patients who visited the department of oral and maxillofacial surgery for the surgical removal of mesioangular impacted third molar were assessed for enrolment. A total of 20 patients participated in this study. Patients were divided into two groups. Group A consisted of patients who received chlorhexidine coated polyglycolic acid sutures. Group B consisted of patients who received silk sutures. Surgical removal of the impacted mandibular third molar was done. Post operatively all Patients in both groups were prescribed with Amoxicillin 500mg for 5 days three times a day and Diclofenac 50 mg thrice daily for 3 days. Patients were asked to report back after a week for review. They were contacted over the telephone to score postoperative pain. If the pain score was greater than 5 they were asked to report to the hospital. Results: In group A a mean postoperative pain score of 4 was observed. In Group B a mean postoperative pain score of 3 was observed.

Apple-peel intestinal atresia treated by diamond-shaped anastomosis to adjust the anastomosis size

An apple-peel intestinal atresia is a rare form of bowel atresia. Herein, reported a case of apple-peel intestinal atresia that was treated with a diamond-shaped anastomosis to adjust the anastomosis size. A female infant was born at 33 weeks of gestation with a birth weight of 1936 g. The prenatal ultrasound revealed proximal intestinal dilatation and polyhydramnios. She had a prenatal diagnosis of suspected congenital jejunal atresia. Post-natal abdominal X-ray showed triple bubble sign with the paucity of gas in the lower bowel, as well as concerned proximal bowel obstruction. She underwent surgical repair for jejunal atresia at 2 days of age. Surgical exploration revealed a markedly distended atretic jejunum with apple-peel jejunal atresia and a significant loss of intestinal length. A difference in the diameter of approximately 3: 1 was found between the oral and the anal intestine, and the end-to-end anastomosis was difficult. Therefore, a diamond-shaped anastomosis was performed using 5-0 polyglycolic acid sutures by incising the dilated oral tract in the minor axis and the anal in the major axis. A trans-anastomotic tube was placed nasally beyond the anastomotic site. The postoperative course was uneventful. Therefore, the diamond-shaped anastomosis may be an option for apple-peel intestinal atresia. • Apple-peel intestinal atresia is a rare form of bowel atresia that affects approximately 1/50000 live births. • In recent years, primary anastomosis with proximal enteroplasty has been successfully performed in patients with apple-peel type congenital small intestinal atresia. • We report a case of apple-peel intestinal atresia that was treated with a diamond-shaped anastomosis to adjust the anastomosis size. • The diamond-shaped anastomosis may be an option for apple-peel intestinal atresia.

Additive manufacture of PCL/nHA scaffolds reinforced with biodegradable continuous Fibers: Mechanical Properties, in-vitro degradation Profile, and cell study

In this study, an innovative method of “in-situ impregnation” was implemented in the Fused Deposition Modeling (FDM) process to produce poly (∊‐caprolactone) (PCL) scaffolds with enhanced mechanical and biological properties utilizing continuous biodegradable polyglycolic acid (PGA) suture yarns. The study aimed to introduce composite scaffolds, having a nominal porosity of 60% and 0°/60°/120° fibers layout, with tunable mechanical and biological properties for tissue engineering applications. Three different fiber volume contents (15, 25, and 35 vol%) were successfully embedded in the specimens during printing. To enhance the compressive properties, nano‐hydroxyapatite (nHA) was added to the PCL matrix in three levels (0, 10, and 20 wt%). Degradation behaviors of both tensile and compression specimens were also assessed in DMEM and Sörensen buffer. The biological properties of the scaffolds, including surface morphology, biocompatibility, and cell adhesion, were also evaluated. According to the results, incorporating the PGA fibers and nHA particles remarkably enhanced mechanical properties, degradation, and cell adhesion. Also, the composite scaffolds exhibited superior water uptake and hydrophilicity compared to the non-reinforced ones. The results suggest that the introduced 3D printed composite can be produced as a suitable material for bone tissue engineering and resorbable barrier membrane with the desired properties.

Application of self-healing, swellable and biodegradable polymers for wound treatment.

Self-healing, swellable and biodegradable polymers are vital materials that may facilitate the different stages of wound healing. The aim of this research was to prepare wound healing films using self-healing polyvinyl alcohol (PVA), swellable hydroxypropyl methylcellulose (HPMC), biodegradable polyglycolic acid (PGA) sutures and ciprofloxacin antibiotic for improved treatment outcome. Films were formulated through aqueous-based mixing of varying amounts of polyvinyl alcohol (10-20% weight/weight (w/w)) and hydroxypropyl methylcellulose (0.5, 1% w/w) with fixed quantities of ciprofloxacin. PGA sutures were placed as grids within the wet mixtures of the polymers and ciprofloxacin, and thereafter products were air dried. The formulated films were evaluated for swelling ratio, breaking elongation, folding endurance, moisture uptake and loss, compatibility and in vitro antibiotic release. Furthermore, in vivo wound healing was studied using excision model and histopathological examinations. Swelling ratios were above 1.0 and the films were minimally stretchable, with folding endurance greater than 500. Films were stable while moisture uptake and loss were observed to be less than 30%. Among the optimised hydrogel batches, those containing 10% w/w PVA and 1% w/w HPMC with no PGA showed the highest drug release of 73%, whereas the batches with higher PGA content showed higher percentage wound size reduction with minimal scar. The completeness of wound healing with batches containing PVA, HPMC, ciprofloxacin and PGA, along with the standard, is evident considering the massive cornification, regeneration of the epithelial front and stratum spinosum. The findings show that polymer-based multifunctional composite films are suitable for use as dressings for improved wound healing.

Surgical treatment of canine and feline descemetoceles, deep and perforated corneal ulcers with autologous buccal mucous membrane grafts.

ObjectivesTo report the surgical technique and postoperative outcome of corneal repair with autologous buccal mucous membrane grafts in dogs and cats with descemetoceles, deep corneal ulcers, and perforated corneal ulcers with or without iris prolapse.Animal studiedTwelve cats (13 eyes) and fourteen dogs (14 eyes) were treated.ProceduresGrafts were harvested from the unpigmented superior labial mucosa using a biopsy punch. The corneal lesion was carefully debrided and cleaned. The graft was secured to the healthy cornea with a combination of simple interrupted and continuous 9–0 polyglycolic acid sutures. In 25/27 treated eyes, an overlying pedicle conjunctival graft was also performed. A temporary nictitating membrane flap was used in all cases. The pedicle conjunctival graft was trimmed about 10–20 days postoperatively. The median follow‐up period was 549.2 days (range 14–2691 days).ResultsNo surgical intra‐operative complications were observed. The ulcers healed and the integrity of the globe was restored in 24/27 treated eyes. Different grades of corneal fibrosis and/or vascularization and/or pigmentation were observed in all cases at the long‐term follow‐up. In two cases, enucleation was performed due to postoperative complications and one animal developed phthisis bulbi. A total of 22/27 treated eyes appeared to have regained effective visual function at the last clinical evaluation.ConclusionsAutologous buccal mucous membrane grafts appear to successfully manage severe corneal ulcers in dogs and cats, providing a useful and economical alternative to other corneal grafts.

A comparative microbiological study of polyglycolic acid and silk sutures in oral surgical procedures.

Bacterial adherence to silk and polyglycolic acid suture is similar. Literature has shown bacterial adhesion is lower degree in polyglycolic acid suture compared to silk, but tissue reaction was more in the polyglycolic acid suture. The aim of the study was to compare the bacteria adhered on the silk and polyglycolic acid sutures. Sixty-two patients who fulfilled the inclusion criteria were included in the study and were divided equally into group A and group B. After intraoral surgical procedures the operated site was sutured either with 3-0 black silk or 3-0 polyglycolic acid sutures in group A and B respectively. On seventh day after irrigation with normal saline sutures were removed and one suture strand was transported to the Department of Microbiology to inoculate and identify the bacteria. 3-0 black silk exhibited a high degree of aerobic bacteria. The bacteria identified on the suture were Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus viridians, Enterobacter, Escherichia coli, Citrobacter and Klebsiella. In 3-0 polyglycolic acid suture Pseudomonas aeruginosa, E. coli, Streptococcus viridians bacteria were identified. PGA showed fewer bacterial adherences compared to black silk. Fewer bacterial adherence and resorbable PGA makes a better choice for intra oral surgical procedures.

Comparison between tensile characteristics of various suture materials with two suture techniques: an in vitro study.

The first objective of the present study was to evaluate the tensile strength and elongation to failure of commonly used suture materials in oral surgery. As a secondary objective, it was aimed to make a comparison between two different suture techniques within the same suture materials. Eight different suture materials with 3-0 gauge (silk, polytetrafluoroethylene, polypropylene, polyester, polyglactin 910, polyglycolic acid, poliglecaprone 25, polydioxanone) underwent tensile testing for maximum load of failure and elongation rate. All strands were tied by one investigator on the experimental platform using the surgeon's knot plus additional square knots in both simple suture and horizontal mattress suture techniques. Prepared specimens were examined using a microtensile testing device before (baseline) and after 3, 7, and 14 days' immersion in artificial saliva. Statistical analysis of the current study revealed that the tensile strength for polyglycolic acid, polyglactin 910, polypropylene, and silk sutures was significantly lower at day 3 than at the baseline. By day 14, polyglycolic acid and polyglactin 910 showed a significant reduction in tensile strength for both techniques. While polydioxanone obtained the highest tensile strength and elongation values in both techniques, polytetrafluoroethylene showed the most stable tensile strength even with the lowest value. Tensile strength in simple suture techniques was almost twice than that of horizontal mattress suture technique for each specimen. Polyglycolic acid and polyglactin 910 were considerably sensitive to immersion time. Polydioxanone demonstrated optimum performance during each immersion period among the tested materials, whereas polytetrafluoroethylene was the most stable. The selection of the most proper suture material remains challenging for clinicians. The present study provides relevant information for clinicians to guide them in their choice of the suitable material. In this context, clinicians can benefit from the use of polydioxanone for its high tensile strength regardless of the suture technique used, whereas polytetrafluoroethylene shows a long-term stability. The strength and stability differences among suture materials and techniques need to be considered before making an informed decision.

Facile Synthesis of Antimicrobial Aloe Vera-"Smart" Triiodide-PVP Biomaterials.

Antibiotic resistance is an eminent threat for the survival of mankind. Nosocomial infections caused by multidrug resistant microorganisms are a reason for morbidity and mortality worldwide. Plant-based antimicrobial agents are based on synergistic mechanisms which prevent resistance and have been used for centuries against ailments. We suggest the use of cost-effective, eco-friendly Aloe Vera Barbadensis Miller (AV)-iodine biomaterials as a new generation of antimicrobial agents. In a facile, one-pot synthesis, we encapsulated fresh AV gel with polyvinylpyrrolidone (PVP) as a stabilizing agent and incorporated iodine moieties in the form of iodine (I2) and sodium iodide (NaI) into the polymer matrix. Ultraviolet-visible spectroscopy (UV-Vis), Fourier transform infrared spectroscopy (FT-IR), x-ray diffraction (XRD), microstructural analysis by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) verified the composition of AV-PVP-I2, AV-PVP-I2-NaI. AV, AV-PVP, AV-PVP-I2, AV-PVP-I2-NaI, and AV-PVP-NaI were tested in-vitro by disc diffusion assay and dip-coated on polyglycolic acid (PGA) sutures against ten microbial reference strains. All the tested pathogens were more susceptible towards AV-PVP-I2 due to the inclusion of “smart” triiodides with halogen bonding in vitro and on dip-coated sutures. The biocomplexes AV-PVP-I2, AV-PVP-I2-NaI showed remarkable antimicrobial properties. “Smart” biohybrids with triiodide inclusions have excellent antifungal and promising antimicrobial activities, with potential use against surgical site infections (SSI) and as disinfecting agents.

Outcomes of Liquifying PLDLLA Suture Anchor for Lateral Ligament Reconstruction of the Ankle

Liquifying poly-DL lactic acid (PLDLLA) suture anchors represent a novel fixation technique in lateral ligament reconstruction. Biomechanical testing has demonstrated that these bone-welding anchors have significant resistance to pullout in cancellous bone. To determine if this superior strength translates to improved clinical outcomes, an initial evaluation of complications and patient-reported outcomes of ultrasound-activated anchor fixation was conducted. A chart review of prospectively collected data were conducted on 8 patients who underwent a modified Broström technique using bone-welding technology for lateral ligament fixation. All surgeries were performed by a single surgeon, for similar clinical indications, and utilized 1 or 2 ultrasound-activated anchors. Clinical data and postoperative patient-reported outcomes (visual analog scale and Short Form Health Survey-36) were collected over 1 year and analyzed. Preoperative, 6-month, and 1-year visual analog scale scores were 4.3±1.9 (range, 2 to 7), 0.7±1.5 (range, 0 to 4) (P=0.004), and 0±0 (P=0.002), respectively. The Short Form Health Survey-36 preoperative, 6-month, and 1-year physical functioning scale scores were 61.3±31.3 (range, 15 to 100), 87.5±16.9 (range, 50 to 100) (P=0.024), and 98.6±2.4 (range, 95 to 100) (P=0.0096), respectively. There were no major complications. Use of ultrasonic-activated anchors demonstrated improvement in patient-reported outcomes with a low incidence of clinical complications. Future work is needed to confirm these findings in a larger sample and directly compare these anchors with the current leading fixation devices. Level of Evidence: Diagnostic Level IV, Case Series. See Instructions for Authors for a complete description of levels of evidence.

Isthmocele—a New Obstetric Surgery Sequela for Laparoscopic Surgeons

Cesarean section is a common obstetric surgery worldwide. It leads to hitherto unrecognized but not too uncommon sequela known as isthmocele—which is a cesarean section scar defect in the uterus which goes mostly unrecognized and is not cared for. It is certainly not asymptomatic nor totally benign. Such patients suffer from lower abdominal pain, abnormal menstrual bleeding, and secondary infertility including in vitro fertilization (IVF) failure, and they were not responding to a medical treatment. This defect was recognized in a case series of 17 patients and was successfully treated by a laparoscopy repair. Saline-filled hysteroscopy (5 mm) along with an ultrasound examination was the main diagnostic modality. The laparoscopic procedure under general anesthesia included adhesiolysis if any, the lower uterine segment scar excision assisted by transvaginal illumination, and intra-corporeal re-suturing of uterine defect using a number zero polyglycolic acid suture in 2 layers. The post-menstrual bleeding abated in all 17 patients; 6/17 desired a 2nd pregnancy and they are under observation.

Human Acellular Dermal Matrix Augmentation Phalloplasty Surgery

Many men often have the need to enlarge their penises for psychological gain and to satisfy or to impress their partners. Many surgical techniques have been reported. However, none is the gold standard. To evaluate the efficacy and safety of human acellular dermal matrix allograft in augmentation phalloplasty technique. From March 2015 to September 2017, a total of 182 patients were prospectively recruited into our cohort after complete physical and psychological evaluation that deemed suitable for penile enhancement. Penis circumference was measured at the mid-length of the penis. Mean was 7.03 cm (6.93 ± 1.00 cm) and 12.1 cm (10.59 ± 1.15 cm) during flaccid and erection, respectively. All patients received human acellular dermal matrix graft under spinal or local anesthesia. The allograft was preconditioned in normal saline for 20 minutes, and mesh incisions were made to optimize blood flow. The width was equal to the circumference of both corpus cavernosa but without corpus spongiosum. The length of the graft was determined by measuring the length between the tip of the coronary sulcus and the root of penis. A complete incision below the coronary sulcus to the depth of the Buck's fascia was made. Then separate the dartos fascia from the Buck's fascia. The prepared graft was then placed on top of the Buck's fascia, with the blood-remained side facing the Buck's fascia. The graft was sutured using 4-0 absorbable polyglycolic acid suture to the Buck's fascia. Extra caution needed to be taken when fixing ventrally to avoid injuring the urethra. Once completed, the dartos fascia was restored, the dartos fascia and subcutaneous tissue were sutured with 4-0 absorbable suture, and skin closure is achieved subsequently. The post-operative course was without complications. At the follow-up after 1 year, the mean flaccid girth increased to 8.07 ± 1.06 cm (P < .05), while the mean erect girth increased to 12.79 ± 1.23 cm (P < .05). Sexual activity was allowed after 8 weeks of surgery. The majority reported that sexual self-esteem and functioning significantly improved. In addition, 59 patients reported alleviation of premature ejaculation. Compared to autologous dermis-fat graft and xenograft, augmentation phalloplasty using human acellular dermal matrix has several advantages: (1) it avoids harm harvesting site of the autograft; (2) the effects of dermis allograft can last at least 1 year; and (3) acellular dermal matrix is more likely to be accepted by people.

"Smart" Antimicrobial Nanocomplexes with Potential to Decrease Surgical Site Infections (SSI).

The emergence of resistant pathogens is a burden on mankind and threatens the existence of our species. Natural and plant-derived antimicrobial agents need to be developed in the race against antibiotic resistance. Nanotechnology is a promising approach with a variety of products. Biosynthesized silver nanoparticles (AgNP) have good antimicrobial activity. We prepared AgNPs with trans-cinnamic acid (TCA) and povidone–iodine (PI) with increased antimicrobial activity. We synthesized also AgNPs with natural cinnamon bark extract (Cinn) in combination with PI and coated biodegradable Polyglycolic Acid (PGA) sutures with the new materials separately. These compounds (TCA-AgNP, TCA-AgNP-PI, Cinn-AgNP, and Cinn-AgNP-PI) and their dip-coated PGA sutures were tested against 10 reference strains of microorganisms and five antibiotics by zone inhibition with disc- and agar-well-diffusion methods. The new compounds TCA-AgNP-PI and Cinn-AgNP-PI are broad spectrum microbicidal agents and therefore potential coating materials for sutures to prevent Surgical Site Infections (SSI). TCA-AgNP-PI inhibits the studied pathogens stronger than Cinn-AgNP-PI in-vitro and on coated sutures. Dynamic light scattering (DLS), ultraviolet-visible spectroscopy (UV-Vis), Fourier Transform infrared spectroscopy (FT-IR), Raman, X-ray diffraction (XRD), microstructural analysis by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) confirmed the composition of TCA-AgNP-PI and Cinn-AgNP-PI. Smart solutions involving hybrid materials based on synergistic antimicrobial action have promising future perspectives to combat resistant microorganisms.

3D printed PCL scaffold reinforced with continuous biodegradable fiber yarn: A study on mechanical and cell viability properties

In this study, poly (ε‐caprolactone) (PCL) scaffolds were printed and reinforced, simultaneously, with biodegradable poly glycolic acid (PGA) suture yarn, as a continuous reinforcing fiber, in the Fused Deposition Modeling (FDM) 3D printing process. Albeit PCL is a suitable material for biomedical applications, its low mechanical properties, and low degradation rate have limited its usage. A biocompatible suture yarn was used as the reinforcing material to enhance the mechanical properties and biodegradation characteristics, via an innovative method of continuous fiber embedding in the FDM process. The reinforced PCL samples were 3D printed with the setting porosity value of 60% and 0°/60°/120° lay-down pattern. The mechanical and biological properties of the scaffolds were tested to prove the effectiveness of the produced scaffolds for bone substitute purposes. Mechanical properties assessments showed that with a 22 vol.% suture yarn content in the 3D printed PCL scaffolds, the tensile strength, and elastic modulus remarkably increased up to 374% and 775%, respectively. The degradation of the reinforced PCL was 20 times higher than that of the non-reinforced PCL samples, after ten weeks, dominated by the fiber degradation phenomenon. After three days of cell culture, the proliferation assay of the built scaffovd the non-toxicity of the reinforced PCL.

Cesarean bladder injury - obstetrician's nightmare.

Urinary bladder is an adjacent viscus susceptible for intraoperative injury during cesarean section (CS). Prolonged labor, scarred uterus, intraabdominal adhesion, emergency CS, advanced labor, cesarean hysterectomy etc., are the predisposing factors for bladder injury during CS. While operating on such conditions, one should be meticulous to explore the possibility of bladder injury. Family physician practicing community obstetrics should be aware of this and know how to tackle this. Usually the dome of the bladder is injured and the trigonal area remains away from the injury field by 6–10 cm. Bladder rent is repaired in two layers either by continuous simple or interrupted suture with 3-0 & 2-0 polyglycolic acid suture. Suprapubic cystostomy and transurethral catheter are kept for 10–14 days. While postoperative adhesion, CS during full dilatation of cervix, abnormal anatomy etc., may not proceed for negligence, bladder injury in normal patients and unrecognized intraoperative bladder injury may attract penalty from the consumer court.