Antibacterial Suture Research Articles

Green and safe preparation of antibacterial sutures composed of PLA ultrafine fibers

AbstractThe electrospun yarn for sutures has gained worldwide attention due to its fine fibers that resemble the extracellular matrix and its abundant functional sites. However, the use of a large number of toxic solvents poses safety risks and environmental pollution during production, making it challenging to directly apply electrospun yarn in the biomedical field. In this study, an environmentally friendly and safe method without toxic solvents was proposed for preparing antibacterial PLA ultrafine fiber sutures. This method involves melt electrospinning, hot‐stretching, low‐temperature plasma treatment, and chitosan grafting. The PLA ultrafine fiber sutures exhibit a high tensile strength which is 2.04 N before knotting and 1.57 N after knotting. The suture diameter is 118.7 μm and average fiber diameter is 1.72 μm. Chitosan grafted on the fiber surface provides excellent antibacterial properties for the sutures, with antibacterial rates against Escherichia coli and Staphylococcus aureus reaching 99.89% and 99.11%, respectively. The cell survival rate is 97.33%, while hemolysis rate is only 2.35%, demonstrating excellent biocompatibility of PLA ultrafine fiber sutures. This study presents a green and safe method for preparing clinically applicable absorbable antibacterial surgical sutures with high mechanical properties.Highlights A green and safe method for preparing PLA‐CS ultrafine fiber sutures. PLA‐CS suture with a tensile strength of 2.04 N and a fiber diameter of 1.72 μm. PLA‐CS suture with good antibacterial property and biocompatibility.

Peptide-AIE Nanofibers Functionalized Sutures with Antimicrobial Activity and Subcutaneous Traceability.

As one of the most widely used medical devices, sutures face challenges related to surgical site infections (SSIs) and lack of subcutaneous traceability. In the present study, a facile and effective approach using peptide-AIE nanofibers (NFs-K18) to create fluorescent-traceable antimicrobial sutures, which have been applied to four commercially available sutures is developed. The functionalized sutures of PGAS-NFs-K18 and PGLAS-NFs-K18 exhibit fluorescence with excellent penetration from 4mm chicken breasts. They also demonstrate remarkable stability after 24h of white light illumination and threading through chicken breasts 10 times. These sutures efficiently generate ROS, resulting in significant suppression of four clinical bacteria, with the highest antimicrobial rate of ≈100%. Moreover, the sutures exhibit favorable hemocompatibility and biocompatibility. In vivo experiments demonstrate that the optimized PGLAS-NFs-K18 suture displays potent antimicrobial activity against MRSA, effectively inhibiting inflammation and promoting tissue healing in both skin wound and abdominal wall wound models, outperforming the commercially available Coated VICRYL Plus Antibacterial suture. Importantly, PGLAS-NFs-K18 exhibits sensitive subcutaneous traceability, allowing for accurate in situ monitoring of its degradation. It is believed that this straightforward strategy offers a new pathway for inhibiting SSIs and monitoring the status of sutures.

Continuous fabrication of braided composite nanofibrous surgical yarns using advanced AC electrospinning and braiding technology

Composite nanofibrous yarns (CNY), featuring a submicron electrospun sheath coated on a micro-scale core yarn have gained attention within the academic and industrial communities due to their unique structure. When braided, these CNYs hold great promise as next-generation surgical yarns. However, large-scale production of CNYs using conventional electrospinning techniques remains technologically challenging, and maintaining the integrity of the fibrous sheath during braiding presents further difficulties. Here, we propose a novel approach for continuously fabricating functional braided CNYs using collectorless alternating current (AC) electrospinning and braiding technology. Our approach utilized polycaprolactone-polylactic acid (PCL-PLA) blends and PCL-PLA with chlorhexidine (CHX) or triclosan (TRC) electrospun fibers for the sheath layer, while PLA micro-yarns acted as the core layer. Morphological analyses confirmed the successful fabrication of braided CNYs. Additionally, infrared spectroscopy validated the presence of CHX or TRC in the resulting yarns. The resulting braided CNYs exhibited excellent breaking force (29 N) and thermal stability (270 °C). Cytotoxicity and antibacterial assessments demonstrated that CHX-loaded braided CNYs could serve as biocompatible antibacterial surgical sutures. The proposed method offers a versatile approach for producing various functional braided CNYs applicable in tissue engineering scaffolds, filters, wearable electronics, and sensors.

Braided silk sutures coated with photoreduced silver nanoparticles for eradicating Staphylococcus aureus and Streptococcus mutans infections

BackgroundInfections resulting from surgical procedures and wound closures continue to pose significant challenges in healthcare settings. To address this issue, the investigators have developed antibacterial non-resorbable braided silk sutures using in situ deposited silver nanoparticles (AgNPs) and investigated their efficacy in eradicating Staphylococcus aureus and Streptococcus mutans infections. MethodsThe braided silk sutures were modified through a simple and efficient in situ photoreduction method, resulting in the uniform distribution of AgNPs along the suture surface. The synthesized AgNPs were characterized using scanning electron microscopy (SEM), dynamic light scattering analysis (DLS) and Fourier Transform Infrared Spectroscopy analysis (FTIR) confirming their successful integration onto the silk sutures. The antibacterial activity of the nanoparticle coated sutures were compared and evaluated with non-coated braided silk sutures through in vitro assays against both S. aureus and S. mutans. ResultsThe surface and cross-sectional analysis of the treated sutures revealed a uniform and homogeneous distribution of silver particles achieved through the photoreduction of silver solution. This observation confirms the successful coating of silver nanoparticles (AgNPs) on the sutures. The antimicrobial studies conducted, demonstrated significant reductions in bacterial colonies when exposed to the silver nanoparticle-coated sutures. Notably, the width of the inhibition zone surrounding the coated sutures remained consistently wide and stable for duration up to 7 days. This sustained and robust inhibitory effect against gram-positive bacteria, specifically S. aureus and S. mutans, serves as strong evidence of the antibacterial efficacy of the coated sutures. ConclusionThe coating of silk sutures with AgNPs provided a significant and effective antibacterial capacity to the surgical sutures, with this activity being sustained for a period of 7 days. This suggests that AgNPs-in situ photoreduction deposited sutures have the potential to effectively manage S. aureus and S. mutans infections.

Pressure-Spun Fibrous Surgical Sutures for Localized Antibacterial Delivery: Development, Characterization, and In Vitro Evaluation.

Surgical sutures designed to prevent infection are critical in addressing antibiotic-resistant pathogens that cause surgical site infections. Instead of antibiotics, alternative materials such as biocides have been assessed for coating commercially used sutures due to emerging antibiotic resistance concerns worldwide. This study has a new approach to the development of fibrous surgical sutures with the ability to deliver localized antibacterial agents. A new manufacturing process based on pressure spinning was used for the first time in the production of fibrous surgical sutures by physically blending antibacterial triclosan (Tri) agent with poly(lactic-co-glycolic acid) (PLGA) and poly(ethylene oxide) (PEO) polymers. Fibrous surgical sutures with virgin PLGA, virgin PEO, different ratios of PLGA-PEO, and different ratios of Tri-loaded PLGA-PEO fibrous sutures were produced to mimic the FDA- and NICE-approved PLGA-based sutures available in the market and compared for their characteristics. They were also tested simultaneously with commercially available sutures to compare their in vitro biodegradation, antibacterial, drug release, and cytotoxicity properties. After in vitro antibacterial testing for 24 h, sutures having 285 ± 12 μg/mg Tri loading were selected as a model for further testing as they exhibited antibacterial activity against all tested bacteria strains. The selected model of antibacterial fibrous sutures exhibited an initial burst of Tri release within 24 h, followed by a sustained release for the remaining time until the sutures completely degraded within 21 days. The cell viability assay showed that these surgical sutures had no cytotoxic effect on mammalian cells.

Evaluation of Microbial Adherence on Antibacterial Suture Materials during Intraoral Wound Healing: A Prospective Comparative Study.

To assess the efficacy of antiseptic-coated silk sutures with triclosan-coated polyglactin 910 suture in reducing bacterial colonization after oral surgical procedures. The patients who required multiple sutures after surgical procedures in the mandible were the study subjects. The sites of suturing were divided into three groups. Group A - surgical site receiving black-braided silk suture (control group). Group B - surgical site receiving triclosan-coated Polyglactin 910 suture (experimental group). Group C - surgical site receiving antiseptic-coated silk suture (experimental group). Evaluation was done on the 3rd postoperative and 7th postoperative day. Microbial adherence was evaluated by microbiological study. The mean comparison of microbial count between 3rd and 7th post-op day in the three groups shows an increased microbial colonization in the control group when compared with the experimental groups. The combined mean microbial adherence in the three groups showed microbial count in the uncoated silk suture (group A) as 10.35 ± 3.74, triclosan-coated suture (group B) as 6.28 ± 2.17 and iodoform + calendula oil-coated suture (group C) as 7.1 ± 2.02 which is statistically significant (p < 0.05). The present research concluded that the pomade-coated silk suture is as efficient as triclosan-coated VICRYL PLUS Polyglactin 910 sutures in reducing the bacterial colonization in intraoral wound healing. The pomade (iodoform + calendula oil) may be advocated in the field of oral and maxillofacial surgery for impregnating the suture materials which act as an antiseptic agent and a promoter of wound healing which is easily accessible and also cost-effective.

Impact of Intraoperative Factors on the Development of Postpartum Septic Complications.

Background and Objectives: Triclosan-coated sutures (antibacterial sutures) can reduce the risk of postoperative surgical site infection. This study aimed to investigate the effect of intraoperative factors, including antibacterial sutures, on the risk of postpartum septic complications. Materials and Methods: The prospective study included patients who underwent caesarean section. The exclusion criterion was chorioamnionitis. The investigation group patient's (n = 67) uterus and fascial sheath of the abdominal wall were sutured with triclosan-coated polyglactin 910 sutures during surgery. The control group consisted of 98 patients using uncoated polyglactin 910 sutures only. The patients were contacted by phone after the 30th postoperative day. Results: No significant difference was found between the investigation group and the control group in the development of postpartum endometritis (11.7% in the investigation group vs. 8.4% in the control group, p = 0.401), wound infection (6.3% vs. 3.6%, p = 0.444) or patients experienced any septic complication (15.9% vs. 12%, p = 0.506). Postpartum endometritis was more common in patients who underwent instrumental uterine examination during the surgery (23.8% vs. 18%, p = 0.043). A moderately strong correlation was found for haemoglobin level on the third-fourth postoperative day with the development of postpartum septic complications, p < 0.001, Pearson coefficient -0.319. Post-caesarean delivery septic complications were not statistically more common in patients with blood loss greater than 1 L. The incidence of post-caesarean endometritis was 13.4%, and wound infection was 4.8% in this study's hospital, having five to six thousand deliveries per year. Conclusions: Using antibacterial sutures during caesarean section does not affect the incidence of postpartum septic complications. Instrumental uterine examination during caesarean section increases the risk of post-caesarean endometritis and is, therefore, not recommended. Haemoglobin level on the 3rd-4th postoperative day, rather than the estimated blood loss during surgery, affects the development of postpartum septic complications.

SP1.3 Implementation of a care bundle to sustainably reduce surgical site infection after emergency laparotomy

Abstract Introduction Surgical site infection (SSI) after emergency laparotomy (EL) is reported in up to 35% of patients. Implementation of the PreciSSIon bundle; 2% chlorhexidine preparation, second-dose antibiotics after 4 hours operating, wound protector (WP), antibacterial sutures for deep and superficial layers, halved SSI after elective colorectal surgery. This project aimed to implement an adapted bundle for EL. Method For patients in hospital at 30 days, notes were reviewed. For those discharged before 30 days patient-reported 30-day SSI was measured using the Public Health England Questionnaire. Baseline data was collected for 1 year with bundle implemented 2020. Additions to bundle were glove change and betadine wound wash. Results 677 patients had EL over 4 years. Average mortality was 10%. A further 10% had laparostomy and temporary VAC dressing. Average response rate to questionnaire was 71%. Compliance with bundle elements were 100% for chlorhexidine, 96% for antibiotic 2nd dose, 83% and 90% for deep and superficial antibacterial sutures, 85% for glove change and betadine. Use of WPs was only 50%. After implementation of the bundle at the beginning of 2020, both patient-reported and in-patient SSI reduced, and total SSI has halved. Conclusion We have demonstrated reliable implementation of a care bundle (excluding WPs) sustainably reduced SSI after emergency laparotomy.

Stage-controlled antibacterial surgical sutures based on curcumin@ZIF-8 functional coating for improved wound healing

Antibacterial surgical sutures play a significant role in preventing incision infections and promoting wound healing. However, the existing antibacterial sutures failed to match well with staged antibacterial requirements during wound healing progress. Herein, to endow the sutures with stage-controlled antibacterial properties, a simple and feasible strategy of decorating the suture surface with curcumin@zeolitic imidazolate framework-8 (Cur@ZIF-8) was proposed. The pH of the microenvironment changes during the wound healing process, which declines to acidic in the early postoperative stage due to the aseptic/bacterial inflammatory infection and returns to normal with wound healing. Coincidentally, benefiting from the pH-responsive behavior of ZIF-8, Zn2+ and Cur could be quickly released under an acidic environment, facilitating bacteria-killing efficiency and preventing surgical site infections timely. The release amount of Zn2+ and Cur decreased under a normal pH environment, protecting the cells/tissues from damage caused by their excessive release. In addition, in vitro and in vivo studies revealed that the developed functional sutures could enhance wound healing, as evidenced by stage-controlled release behavior, good antibacterial activity, reduced inflammatory reaction, re-epithelization, and collagen regeneration. Furthermore, thanks to the gentle preparation process, the original mechanical property and handling performance of the sutures were preserved, guaranteeing their practical clinical availability.

COMPARATIVE STUDY BETWEEN THE EFFICACY OF CONVENTIONAL PLAIN VICRYL AND ANTIBACTERIAL VICRYL CONTAINING TRICLOSAN

Introduction: Third molar surgeries are the most commonly practiced surgeries in the dental office. The incidence of surgical site infection is still higher in spite of antibiotic prophylaxis owing to the need for the use of alternative measures. Antibacterial sutures are recently being used following third molar surgeries to reduce the incidence of surgical site infections and inflammatory sequels. Objectives: To assess vicryl plus sutures in comparison with conventional plain vicryl in various parameters like swelling, infection, trismus, erythema and pain. Methods: Total of thirty patients having bilateral impacted mandibular third molars were selected. Plain vicryl was used for primary closure after disimpaction on the former side (Group A) and vicryl plus containing triclosan for the same on the contralateral side (Group B). Swelling, trismus, erythema, infection and pain were compared between the groups consecutively on 3rd, 7th, 15th days and one month. The observations and results were compiled. Results: The study yielded significant statistical results in terms of trismus, pain and erythema although the numerical significance was seen in all parameters. Conclusion:Vicryl suture containing triclosan was comparatively more effective in reducing the post-surgical sequel after third molar surgery than conventional plain vicryl suture.

Sustainable Antibacterial Surgical Suture Based on Recycled Silk Resource by an Internal Combination of Inorganic Nanomaterials.

The current antibacterial treatment methods of silk sutures can only be finished by surface modification, leading to problems of short antibacterial effects, easy slow-release consumption, prominent toxicity, and susceptibility to drug resistance. Speculatively, surgical sutures combining antibacterial material internally will possess a more promising efficacy. Hence, we extracted recycled regenerated silk fibroin (RRSF) from waste silk resources to make RRSF solutions. Internally combining with inorganic titanium dioxide (TiO2) nanoparticles, we fabricated antibacterial RRSF-based surgical sutures. The morphologies, mechanical and antibacterial properties, biocompatibility tests, and in vivo experiments were carried out. The results showed that the surgical sutures with 1.25 wt % TiO2 acquired 2.40 N knot strength (143 μm diameter) and achieved a sustainable antibacterial effect of 93.58%. Surprisingly, the sutures significantly reduced inflammatory reactions and promoted wound healing. Surgical sutures in this paper realize high-value recovery of waste silk fibers and provide a novel approach to preparing multifunctional sutures.

Antibacterial Surgical Sutures Developed Using Electrostatic Yarn Wrapping Technology.

A significant amount of research has been conducted on applying functional materials as surgical sutures. Therefore, research on how to solve the shortcomings of surgical sutures through available materials has been given increasing attention. In this study, hydroxypropyl cellulose (HPC)/PVP/zinc acetate nanofibers were coated on absorbable collagen sutures using an electrostatic yarn winding technique. The metal disk of an electrostatic yarn spinning machine gathers nanofibers between two needles with positive and negative charges. By adjusting the positive and negative voltage, the liquid in the spinneret is stretched into fibers. The selected materials are toxicity free and have high biocompatibility. Test results indicate that the nanofiber membrane comprises evenly formed nanofibers despite the presence of zinc acetate. In addition, zinc acetate can effectively kill 99.9% of E. coli and S. aureus. Cell assay results indicate that HPC/PVP/Zn nanofiber membranes are not toxic; moreover, they improve cell adhesion, suggesting that the absorbable collagen surgical suture is profoundly wrapped in a nanofiber membrane that exerts antibacterial efficacy and reduces inflammation, thus providing a suitable environment for cell growth. The employment of electrostatic yarn wrapping technology is proven effective in providing surgical sutures with antibacterial efficacy and a more flexible range of functions.

Implementation of intraoperative wound irrigation with aqueous 10% povidone-iodine and triclosan-coated sutures is not effective for reducing the incidence of incisional surgical site infection after major hepato-biliary-pancreatic surgery in patients with preoperative biliary drainage.

Patients who receive preoperative biliary drainage (PBD) and biliary reconstruction are most at risk for incisional surgical site infection (SSI) in major hepatobiliary-pancreatic (HBP) surgery. We evaluated 72 patients with PBD who underwent major HBP surgery and received intraoperative wound irrigation (IOWI) with saline and standard sutures between March 2014 and March 2017 (Cohort 1) and 63 patients with PBD who underwent major HBP surgery and received IOWI with aqueous 10% povidone-iodine and antibacterial sutures between June 2019 and February 2022 (Cohort 2). We compared the incidence of incisional SSI between the two cohorts. Twenty-seven (20.0%) of 135 patients developed incisional SSIs. The rate of current smoking was more frequent in patients who developed incisional SSIs than in those who did not (37.0% vs. 14.8%, p=.012). A total of 18 (25%) of 72 patients developed incisional SSI in Cohort 1, and nine (14.3%) of 63 developed incisional SSI in Cohort 2. Cohort 2 had a 10% lower incidence of incisional SSI than Cohort 1, a nonsignificant difference (p=.09). The implementation of IOWI with aqueous 10% PVP-I and antibacterial sutures failed to significantly reduce the incidence of incisional SSI in comparison to IOWI with saline and standard sutures in major HBP surgery.

Tensile and stress relaxation characteristics of hybrid PLA-PVA/CS yarns loaded with antibiotic tetracycline hydrochloride used as suture

Antibacterial suture yarns with antibiotic drugs can be applied to protect wounds; so, they can play an important role in preventing and treating the infection. Engineered sutures are expected to have biomechanical properties, i.e. tensile and viscoelastic behavior, for final applications. This research is aimed to consider the tensile and stress-relaxation behavior of drug loaded and raw hybrid suture yarns with the nano-size structure from a mixture of PolyVinyl Alcohol/ChitoSan (PVA/CS) and Poly Lactic Acid (PLA); this was assessed using the electrospinning method. After optimizing the condition for the fabrication of structure, the selection of the finest diameter was done Then, the drug loaded PLA-PVA/CS nanofiber (PLA/TCH-PVA/CS) with the optimum condition was produced and tetracycline hydrochloride (5% wt) was loaded in the PLA solution; after that, both samples were twisted for manufacturing the suture yarns. FTIR and contact angle analysis were then conducted to characterize the samples. Following that, the tensile and stress relaxation of both samples were tested and simulated by the linear standard solid model, considering the mechanical characteristics of the requested suture. As a general conclusion, the experimental tensile results showed that with loading the drug, stress at 0.3 min and initial curve slopes in the tensile tests were reduced; however, the absolute initial discharge curve slopes values in stress relaxation results were also raised by loading the drug.

PreciSSIon: a collaborative initiative to reduce surgical site infections after elective colorectal surgery

Surgical site infections (SSIs) are common after colorectal surgery, but most hospitals do not know their SSI rates. Approximately half of SSIs occur after discharge, and postdischarge surveillance is needed for accurate measurement. Perioperative care bundles are known to reduce SSI rates. PreciSSion is a collaboration between seven hospitals in the West of England. To establish reliable SSI measurement after elective colorectal surgery using 30-day patient-reported outcome measures, and to implement an evidence-based four-point care bundle that had already demonstrated a reduction in the SSI rate in a local hospital. The bundle included: 2% chlorhexidine skin preparation, a second dose of antibiotic after 4h, use of a dual-ring wound protector, and use of antibacterial sutures for abdominal wall closure. The 30-day patient-reported SSI rate was determined using the Public Health England questionnaire, and response rates were recorded. The baseline SSI rate was measured from November 2019 to May 2020, and continued after implementation of the care bundle until March 2021. Bundle compliance was also measured. The average questionnaire response rate was 81%, and average compliance was 92%, 96%, 79% and 85% for each element of the bundle. The baseline SSI rate was 8-30%. Six of seven hospitals reduced their SSI rate, and the regional average SSI rate almost halved from 18% (1447 patients) to 9.5% (1247 patients). A care bundle developed in a single hospital can be adopted in other hospitals, and a 50% reduction in SSI rate after elective colorectal surgery can be replicated in other hospitals within 18 months.

Triclosan-coated barbed sutures in elective laparoscopic colorectal cancer surgery: a propensity score matched cohort study

BackgroundMost of the studies published to date which assess the role of antibacterial sutures in surgical site infection (SSI) prevention include heterogeneous groups of patients, and it is therefore difficult to draw conclusions. The objective of the present study was to investigate whether the use of Triclosan-coated barbed sutures (TCBS) was associated with a lower incidence of incisional SSI and lower duration of hospital stay compared to standard sutures, in elective laparoscopic colorectal cancer surgery.MethodObservational including patients who underwent elective colorectal cancer laparoscopic surgery between January 2015 and December 2020. The patients were divided into two groups according to the suture used for fascial closure of the extraction incision, TCBS vs conventional non-coated sutures (CNCS), and the rate of SSI was analysed. The TCBS cases were matched to CNCS cases by propensity score matching to obtain comparable groups of patients.Results488 patients met the inclusion criteria. After adjusting the patients with the propensity score, two new groups of patients were generated: 143 TCBS cases versus 143 CNCS cases. Overall incisional SSI appeared in 16 (5.6%) of the patients with a significant difference between groups depending on the type of suture used, 9.8% in the group of CNCS and 1.4% in the group of TCBS (OR 0.239 (CI 95%: 0.065–0.880)). Hospital stay was significantly shorter in TCBS group than in CNCS, 5 vs 6 days (p < 0.001).ConclusionTCBS was associated with a lower incidence of incisional SSI compared to standard sutures in a cohort of patients undergoing elective laparoscopic colorectal cancer surgery.Graphical abstract

Antibacterial Sutures Coated with Smooth Chitosan Layer by Gradient Deposition

Antibacterial Sutures Coated with Smooth Chitosan Layer by Gradient Deposition

Fabrication and Characterization of Antibacterial Suture Yarns Containing PLA/Tetracycline Hydrochloride-PVA/Chitosan Nanofibers

Fabrication and Characterization of Antibacterial Suture Yarns Containing PLA/Tetracycline Hydrochloride-PVA/Chitosan Nanofibers

Sustainable Antibacterial and Anti-Inflammatory Silk Suture with Surface Modification of Combined-Therapy Drugs for Surgical Site Infection.

Silk sutures with antibacterial and anti-inflammatory functions were developed for sustained dual-drug delivery to prevent surgical site infections (SSIs). The silk sutures were prepared with core-shell structures braided from degummed silk filaments and then coated with a silk fibroin (SF) layer loaded with berberine (BB) and artemisinin (ART). Both the rapid release of drugs to prevent initial biofilm formation and the following sustained release to maintain effective concentrations for more than 42 days were demonstrated. In vitro assays using human fibroblasts (Hs 865.Sk) demonstrated cell proliferation on the materials, and hemolysis was 2.4 ± 0.8%, lower than that required by ISO 10993-4 standard. The sutures inhibited platelet adhesion and promoted collagen deposition and blood vessel formation. In vivo assessments using Sprague-Dawley (SD) rats indicated that the coating reduced the expression of pro-inflammatory cytokines interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α), shortening the inflammatory period and promoting angiogenesis. The results demonstrated that these new sutures exhibited stable structures, favorable biocompatibility, and sustainable antibacterial and anti-inflammatory functions with potential for surgical applications.

Microbiological Evaluation of the Antibacterial Vicryl Suture in the Mandibular Third Molar Extraction Surgery

Microbiological Evaluation of the Antibacterial Vicryl Suture in the Mandibular Third Molar Extraction Surgery