Acid Sutures Research Articles

Clinical Comparison of Polyglactic Acid (Vicryl) and Polytrimethylene Carbonate (Maxon) Suture Material

Over a 1-year period, 584 repairs of surgical defects were completed using two different synthetic absorbable sutures, polyglactic acid (Vicryl) and polytrimethylene carbonate (Maxon). No difference in scar width or postoperative complications were found between the two sutures, but polytrimethylene carbonate (Maxon) demonstrated preferable handling and tying characteristics.

Laparotomy closure reinforced with buried polyglyconate retention sutures

A method of laparotomy closure using continuous no. 0 polyglycolic acid suture for accurate fascial approximation and buried retention sutures of no. 1 polyglyconate for prolonged wound strength is described. Both security and anatomical precision in fascial closure are achieved without the use of nonabsorbable suture material. This method of laparotomy closure is suitable for patients at high risk for fascial dehiscence.

Ostioplasty: A Simple Technique for Ureterovesical Reconstruction following Intravesical Ureterocelectomy

A simple operation for the management of simple, i.e. intravesical, ureteroceles, which we have named 'ostioplasty', is presented. After unroofing the ureterocele, the retracted, gaping ureteric ostium is advanced and fixed medially to the center of the bladder trigone with three 5-0 polyglycolic acid sutures. The exposed intravesical ureter is covered with a new mucosal layer formed from the mobilized lateral edges of the unroofed ureterocele, sutured together over the ureter with 5-0 polyglycolic acid. Ostioplasty has been used in 5 patients so far with excellent anatomic and functional results. It is a simple and valuable surgical option to standard ureterovesical reimplantation after excision of a simple ureterocele, provided that the ureterocele is of moderate size and the bladder trigone retains good muscular support.

A New Technique for Ileal Nipple Fixation: Preliminary Report

A new technique for ileal nipple fixation is described in 6 post-cystectomy patients (4 with an ileal bladder substitute and 2 with an ileal reservoir) for the prevention of reflux. Nipple formation is helped by deperitonealization and defatting of the nipple mesentery. A full circumferential incision is made, except for the mesenteric border, and through both nipple layers down to the mucosa of the inner layer. The seromuscular layers on each side of the incision are closed together with continuous 3-zero polyglycolic acid suture. The overlying outer mucosa of both edges then is closed. Endoscopic and radiographic study 6 to 12 months postoperatively showed a stable nipple without reflux. The anatomical and physiological rationale of the technique is discussed. (J. Urol., 144: 1192–1193, 1990)

Anastomotic stricture following repair of esophageal atresia

Anastomotic strictures developed in 74 (37.2%) of 199 patients undergoing primary or delayed primary repair of esophageal atresia with or without tracheoesophageal fistula. Significant predisposing factors included the use of braided silk sutures (relative risk 1.72 and 1.49, compared with polyglycolic acid and polypropylene sutures), the presence of gastroesophageal reflux and leakage of the anastomosis (relative risk 2.29 and 2.04, respectively). Tracheomalacia, personnel factors, and recurrent fistula did not affect the rate of stricture formation. Seventy-one patients responded to dilatation alone, whereas three required stricture resection or esophageal substitution. All three patients requiring surgical intervention and 14 requiring five or more dilatations developed symptoms within the first 6 months after esophageal anastomosis. Antireflux surgery was carried out in 19 (25.7%) of the 74 patients.

Episiotomy repair—suture material and short term morbidity

SummaryOne hundred and twenty patients undergoing instrumental delivery during 18 months were allocated at random following delivery to two groups of 60 having their episiotomy repaired with either chromic catgut or poly-glycollic acid (Dexon). All the women were interviewed on the 1st, 3rd and 5th day post partum and the perineum inspected on the 5th day. Assessment of bruising and oedema was scored 0 (none) to 3 (severe), and the patient's subjective discomfort was analysed using a 10 cm visual analogue scale. No difference was found between the two groups with regard to pain reported, or their bruising and oedema scores. There is no evidence from this study that the choice between chromic catgut and polyglycollic acid sutures influences short term morbidity.

Treatment of keloids by single intraoperative perilesional injection of repository steroid.

Keloid management remains controversial, and recurrence and untoward side effects limit the use of many techniques. During a seven-year period, I surgically treated 19 children, aged 3 to 17 (mean 10.5 years), with a total of 28 keloids. After aseptic skin preparation, the interface between the keloid and normal skin or subcutaneous tissue was injected with betamethasone sodium phosphate and betamethasone acetate suspension (Celestone Soluspan). The lesion was excised, and the defect was closed with subcutaneous polyglycolic acid suture. No further therapy was given. There has been no dermal or subcutaneous atrophy, and there have been no recurrences after an average follow-up of 35.5 months (six months to nine years). The technique is simple and successful, and avoids the painful postoperative series of injections often advocated.

The fate of sternotomy scars in children.

The scars from sternal split incisions were examined and rated in 101 consecutive children attending a cardiology clinic at least 1 year after surgery. Each scar was rated as excellent, good, acceptable, or poor. Factors that may correlate with scar quality were analyzed. This analysis showed that poor scars were most likely to have been closed with intracuticular polyglycolic acid suture; males were more likely to have better scars than females; the younger the child at operation, the better was the scar result; and only 18 of the 69 scars that were hypertrophic 1 year postoperatively remained so after a mean of 5.5 years.

Mechanical performance of monofilament synthetic absorbable sutures

The purpose of this study was to evaluate the mechanical performance of two new synthetic monofilament absorbable sutures. The polydioxanone suture is prepared by polymerizing and extruding the monomer, paradioxanone, in the presence of a suitable catalyst. The other suture is a modified polyglycolic acid suture, made by reacting trimethylene carbonate and glycolide. The knot configuration (1 = 1 = 1, 1 × 1 × 1, and 2 = 1 = 1) required for knot security was identical for the two synthetic monofilament sutures. The mean knot breaking strengths for the polydioxanone and modified polyglycolic acid sutures did not differ significantly. The surfaces of these sutures exhibited a low coefficient of friction which was slightly increased by hydration. The most distinctive difference between the handling characteristics of these two sutures was their flexural rigidity. The stiffness of the polydioxanone suture was 60 percent greater than that of the modified polyglycolic acid suture.

In Vitro Comparison of the Properties of Polydioxanone, Polyglycolic Acid and Catgut Sutures in Sterile and Infected Urine

The effect of immersion in sterile urine, infected urine and plasma on the breaking strength and stiffness of polydioxanone (PDS), polyglycolic acid (PGA) and chromic catgut was studied. Tests were done under closely controlled conditions with immersion periods varying from zero to ten days.The breaking strength and stiffness of the three suture materials was not significantly changed by immersion in plasma for periods up to ten days.In sterile urine, PDS lost all of its strength after three days of immersion while PGA lost 64% of its initial breaking strength after ten days. Catgut maintained its strength over the ten day study period.In E. coli-infected urine, PDS lost all of its strength in six days while PGA lost 71% and catgut 8% after ten days.In proteus-infected urine, PDS and PGA lost all their breaking strength after one day of immersion while catgut lost 5.8% of its initial strength after 10 days.Corresponding decreases in stiffness were also observed.

The best suture for hypospadias?

In a study designed to determine the best suture for use in hypospadias surgery, polydioxanone (PDS), chromic catgut, and polyglycolic acid (Dexon) were studied under similar conditions in the penile foreskin of 16 baboons. Gross and microscopic observations were made at intervals of six to forty-eight days. The wounds sutured with catgut were all healed by twenty-four days with complete suture resorption and no evidence of scar formation. Both polyglycolic acid and polydioxanone sutures showed delayed resorption, wound abscesses, and granulomas. Catgut remains the best available suture to use in the penile foreskin. Polyglycolic acid and polydioxanone sutures, because of their prolonged resorption and excess reaction, should not be used in hypospadias surgery.

The effect of annealing treatments on the tensile properties and hydrolytic degradative properties of polyglycolic acid sutures.

The purpose of this research was to examine the effect of annealing treatments on the mechanical properties of polyglycolic acid sutures, and their subsequent influence on PGA degradation properties. An attempt was made to develop a better understanding of the degradation mechanism of synthetic absorbable sutures, including the relationship of their structure, morphology, and mechanical properties. PGA sutures were annealed under selected axial strain (freely hung, 0%, 1%, 10%), at four temperatures (150 degrees C, 170 degrees C, 180 degrees C, 190 degrees C), and two times (5 and 20 min). The annealed PGA specimens were then subjected to hydrolysis in phosphate-buffer solutions (pH = 7.4) for up to 28 days at 37 degrees C. Tensile properties were used to evaluate the effect of annealing treatments. The data were subjected to statistical analysis using the SAS system. All of the one-, and many of the two- and three-factor interactions were found to be statistically significant. Annealing treatments did alter the mechanical properties of PGA sutures, as well as their degradation properties. Except for the increase in tenacity of samples with increasing percent extension, all other respects of the annealing treatments resulted in lower tenacity and breaking elongation when compared with the control samples. Sutures that have been exposed to any level of axial tension during annealing, however, exhibited a lower rate of hydrolytic degradation than the freely hung suture samples. The reduction of the characteristics of fiber structure due to the tendency of the tie-chain molecules to acquire the less constrained conformations and thus to bring the crystal blocks they connect back to the original arrangement before drawing is believed to be responsible for the freely hung specimens to behave quite differently from the clamped and stressed PGA samples.

先天性心疾患に対する血管ふん合術への吸収性縫合糸の応用

先天性心疾患に対する血管ふん合術への吸収性縫合糸の応用

The in vivo and in vitro degradation of poly(glycolic acid) suture material as a function of applied strain

The in vivo and in vitro stability of a degradable suture material, poly(glycolic acid) has been shown to be dependent on the magnitude of a pre-imposed strain. The degradation, monitored by changes in the tensile load at break, was considerably enhanced by pre-straining the material to one half of the normal extension at break, using a novel implantable device.

Castration of horses and donkeys with first intention healing.

A simple technique for castration of adult horses which results in first intention healing was devised. The technique involves a 'closed' castration with or without a transfixed ligature on the spermatic sac and suturing the scrotal skin with polyglycolic acid suture material. The postoperative course was characterised by mild oedema only and by rapid recovery. The results obtained during the course of removing 311 scrotal testes from horses and donkeys of all ages are described and discussed. The technique is readily applicable in the field.

Transepithelial Elimination of Suture Material

To the Editor.— Mehregan's histiopathologic concept of transepithelial elimination 1 (TE) has been sporadically or consistently observed in an increasing number of dermatoses. I recently observed TE of retained suture material via a hair follicle. Report of a Case.— A 68-year-old woman had a basal cell carcinoma excised from the tip of her nose. The elliptical wound was primarily closed with an absorbable, braided polyglycolic acid suture for subcuticular approximation and a monofilament nylon thread for surface suture. The superficial sutures were completely removed four days later. Histologic examination showed the tumor extending to the margin of the excised specimen. Twenty-four days after the original procedure, reexcision of the area was undertaken. Histologic examination of the second specimen disclosed no residual tumor. In the dermis, a granulomatous foreign-body reaction was seen enveloping a dilated hair follicle (Fig 1). The follicular infundibulum was filled with bluish-staining amorphous material, cell debris, brown

Knotting and handling characteristics of coated synthetic absorbable sutures

The purpose of this study was to evaluate the knotting and handling characteristics of the new coated synthetic absorbable sutures. When compared to the coated polyglactin 910 sutures, the coated polyglycolic acid sutures displayed a lower coefficient of friction, encountered less tissue drag forces, and exhibited less flexural rigidity. In the case of sizes O, 2-O, and 3-O coated polyglycolic sutures, knot security was achieved with one less throw than with similar sizes of coated polyglactin 910 sutures. On the basis of these comprehensive mechanical performance tests, the knotting and handling characteristics of the coated polyglycolic acid sutures were judged to be superior to that of the coated polyglactin 910 sutures.

Histologic reaction to a new microsurgical suture in rabbit reproductive tissue

A newly introduced coated polyglactin suture was compared with a polyglycolic acid suture following microsurgical repair of standard rabbit uterine incisions. The degree of inflammatory response and tissue fibrosis for each suture was scored, and the results were compared. At 30 days, an inflammatory response was noted in both groups, with a greater response noted in the polyglycolic acid group. At 90 days, the inflammatory response and tissue fibrosis at the site of repair was evident in both groups, with no significant difference between the groups. The previously reported difference between these two absorbable suture materials in their earlier formulations could not be demonstrated in rabbit reproductive tissue. If an absorbable suture is used for tubal surgery, the choice can be made on considerations other than tissue reactivity.

The effect of gamma irradiation on the enzymatic degradation of polyglycolic acid absorbable sutures.

The purpose of the study was to examine the effect of gamma irradiation on the enzymatic as well as the in vivo degradation of polyglycolic acid sutures. The sutures of size 2-0 were irradiated at dosage levels of 0-20 mrad. The three enzymes chosen for this study were esterase, alpha-chymotrypsin, and trypsin. The irradiated sutures were both immersed in the enzyme solutions; their corresponding buffer controls, and implanted in inbred black-and-white hooded hister rats (Liverpool strain). The degradation of PGA sutures was determined mechanically. Among the three enzymes studied, esterase showed the highest enzymatic effect on the degradation of the unirradiated and irradiated PGA sutures. Trypsin's effect on PGA sutures was not observed until 20 mrad. The findings of trypsin demonstrated the hypothesis that synthetic high molecular weight polymers, which are initially resistant to enzymatic degradation, could become prone to enzymatic attack after altering their physical and chemical structures. Implanted PGA sutures maintained a similar or slightly higher mean tensile breaking strength in in vivo degradation compared to in vitro degradation (0.1M tris buffer of pH = 7.5); these degradation profiles suggest that PGA does not display similar behavior in in vivo and in vitro degradations. The magnitude of dissimilarity depends on the radiation dosage and on the duration of degradation, and is speculated to be attributable to the specific action of enzymes with respect to the configuration and chemical structure of the PGA sutures.

Results of hypospadias repair according to the principle of the buried strip.

The results after hypospadias repair according to methods of Denis Browne and Crawford area evaluated. Chordee release was performed in 361 patients, 41 or 11% of whom had a reoperation. Urethroplasty was done in 479 patients, 372 according to Denis Browne and 107 according to Crawford. Postoperative fistula or rupture of the plasty was recorded in 27% after Denis Browne's method and in 32% after Crawford's method. Stricture formation was low (3%) in all the patients. The use of polyglycolic acid suture in hypospadias repair caused more fistulas than if nylon was used (P less than 0.05).