Barbed Polydioxanone Research Articles

Strength of small-bites abdominal wall closure using different suturing methods and materials in an experimental animal model.

Using small instead of large bites for laparotomy closure results in lower incidence of incisional hernia, but no consensus exists on which suture material to use. This study aimed to compare five different closure strategies in a standardized experimental setting. Fifty porcine abdominal walls were arranged into 5 groups: (A) running 2/0 polydioxanone; (B) interlocking 2/0 polydioxanone; (C) running size 0 barbed polydioxanone; (D) running size 0 barbed glycolic acid and trimethylene carbonate; (E) running size 0 suturable polypropylene mesh. The small-bites technique was used for linea alba closure in all. The abdominal walls were divided into a supra- and infra-umbilical half, resulting in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile force and types of suture failure were registered. The highest tensile force was measured when using barbed polydioxanone (334.8N ± 157.0), but differencesdid not reach statisticalsignificance. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397N vs 271N, p < 0.001). Barbed glycolic acid and trimethylene carbonate failed significantly more often (25% vs 0%, p = 0.008). Based on tensile force, both interlocking and running suture techniques using polydioxanone, and running sutures using barbed polydioxanone or suturable mesh, seem to be suitable for abdominal wall closure. Tensile strength was significantly higher in infra-umbilical abdominal walls compared to supra-umbilical. Barbed glycolic acid and trimethylene carbonate should probably be discouraged for fascial closure, because of increased risk of suture failure.

Knotless barbed suture versus conventional polydioxanone suture material for intraoral surgical incisions - A randomized controlled trial

PurposeTo evaluate and compare the perioperative wound management and healing of intraoral surgical incisions between the conventional and knotless barbed Polydioxanone suture materials. Materials and methodsA Randomized Controlled Trial was conducted with well-constructed inclusion and exclusion criteria. 46 participants were allotted into the control and test groups based on a computer-generated randomization sequence. The materials used were 3–0 Stratafix™ knotless barbed PDS suture and conventional 3–0 Ethicon PDSTMII suture materials. Parameters assessed included intraoperative time taken for closure and assessment with Early Wound Healing Score (EHS) on postoperative day 1 and Landry, Turnbull, and Howley (LTH) Healing index on postoperative days 3 and 7. Statistical analyses were done using the Chi-square test and student's t-test with a p-value less than 0.05 indicating statistical significance. Results32 patients had surgical intervention for maxillofacial fracture management and 14 patient for orthognathic osteotomies. Surgical sites (n = 60) included maxillary and mandibular vestibules. Intraoperative closure time was better in the test group with statistical significance (p-value = 0.0472). The healing scores on the 3rd and 7th postoperative days were compared between the control and test groups exhibiting statistical significance favouring the test group. The p-values were 0.0479 and 0.0393 respectively. ConclusionTo conclude, our study concurred with the existing literature in terms of reduced operating time, and better wound healing observed with the knotless barbed suture. Along with statistical significance, all the variables exhibited clinical relevance and better wound management in the test group.

A novel technique for repositioning facial soft tissues with barbed polydioxanone threads based on the main aging vector force of rejuvenation

Background: With the evolution of facial rejuvenation procedures, thread lifts have gained space among western patients who seek cosmetic improvement without undergo to surgeries. Absorbable wedge-shaped polydioxanone (PDO) sutures are currently available, and in mid-lower face and mandibular jowl lift, threads are most often implanted in a diagonal vector force from medial-inferior up to lateral-superior site, near the temple. Herein, the authors introduce a new technique based on this oblique sum of anti-aging vector force to reposition and anchorage facial soft tissues, aimed for natural youth rejuvenation. Objective: Describe a novel technique for counteracting the facial ptosis and laxity skin, as well as the duration of clinical lifting result and of skin quality improvement. Methods: More than 84 patients were underwent in this thread technique once. The outcomes were assessed objectively using serial photography and subjectively based on the patients’ spontaneous satisfaction through over these 4 years. Complications were also reported. Results: Most patients considered the results satisfactory. The incidence of complications was low, and most of them were minor and temporary. Conclusion: Wedge-shaped PDO thread repositioning and anchorage soft tissue is safe and effective method for rejuvenation.

OC-056 CLOSURE STRENGTH OF SUTURE TECHNIQUES AND SUTURE MATERIALS

Abstract Aim Small bites closure is being implemented as standard of care (SOC) for laparotomy closure, but no consensus on which suture material to use is reached. The aim of our study was to compare biomechanical properties of four different closure techniques to SOC. Materials &amp; Methods Fifty porcine abdominal walls were divided into five groups: 1. SOC (2/0 polydioxanone); 2. interlocking 2/0 polydioxanone; 3. size 0 barbed polydioxanone; 4. size 0 barbed glycolic acid and trimethylenecarbonate (GATC); 5. size 0 suturable polypropylene mesh. The small bites technique was used for closure of the linea alba in all groups. The abdominal walls were divided into a supra- and infra-umbilical half, which resulted in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile strength and types of suture failure were registered. Results The highest tensile strength was measured in the barbed polydioxanone arm (334.8 N ± 157.0) but did not reach statistical significance compared to the other groups. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397 N vs 271 N, p&amp;lt;0.001). Resorbable GATC barbed suture failed significantly more often (25% vs 0%, p = 0.008). Conclusion When using small bites for fascial closure, the highest tensile strength was found using size 0 barbed polydioxanone suture, but results were similar among all groups. Tensile strength in infra-umbilical abdominal walls was significantly higher compared to supra-umbilical. Use of GATC barbed suture should be discouraged, as this suture fails significantly more often.

Efficiency of barbed polydioxanone threads for neck lifting using the tight neck fontana protocol: Series of cases

The aim of these clinical cases descriptions was to describe the clinical results of barbed polydioxanone (PDO) threads in neck lifting using the Tight Neck Fontana Protocol (TNFP). Three-barbed PDO threads (19G or 18G and 150 mm in length) were implanted bilaterally in six female adult patients with an indication for neck lifting. Two threads were inserted in the sub-dermis of the neck through the diagonal vectors from the angle of the mandible toward the midline and fixed with a knot. The third thread was implanted in parallel and just below the first vector. The post-operative results were evaluated by the occurrence of adverse events, scores attributed on a Visual Numerical Scale, questionnaire inquiring the satisfaction patient about the treatment (QSP), and evaluation of photographic records. The results were quite satisfactory on the procedures performed, suggesting the indication of the TNFP using barbed PDO threads for the neck lifting.

Barbed Polydioxanone Sutures for Face Recontouring: Six-Month Safety and Effectiveness Data Supported by Objective Markerless Tracking Analysis.

Barbed polydioxanone (PDO) sutures allowing for minimally invasive skin lifting are broadly and increasingly used in aesthetic dermatology. To describe utilization of diverse barbed PDO sutures for aesthetic facial corrections in Caucasian patients, to evaluate long-term safety and to demonstrate effectiveness in skin tightening, redefinition of facial contours, and tissue elevation. A retrospective chart review of patients routinely treated with barbed PDO sutures on face was performed. Aesthetic improvement was evaluated at 6-, 12- and 24-week posttreatment by the treating physician, patients, and an independent photographic reviewer. Patient's satisfaction with treatment outcome was evaluated. Procedure effects were also objectively measured by markerless tracking analysis. Sixty patients were treated with a total of 388 barbed sutures in various anatomical areas and followed-up for 24 weeks. At Week 24, the aesthetic improvement rate was 80% to 100% (depending on the evaluator), skin movements related to pre-treatment photographs showed significant changes across several different anatomical regions, and 97% of patients were satisfied with the overall treatment outcome. Transient, mild, and short-lasting adverse events, mostly pain and hematoma, occurred in 15% of patients. Barbed PDO sutures are safe and highly effective for aesthetic corrections, with results lasting for at least 24 weeks.

Experiences of barbed polydioxanone (PDO) cog thread for facial rejuvenation and our technique to prevent thread migration

Background One of the most common nonsurgical options for facial rejuvenation is lifting using threads. Application of polydioxanone (PDO) threads is generally secure and effective procedure, but complications on the involved regions can occur. Objective In this study, we shared our experiences of efficacy and safety of PDO thread lifting for facial rejuvenation and presented our technique to prevent the migration of threads. Materials and methods Thirty-eight patients who underwent PDO cog treatment for facial rejuvenation were evaluated. Via 23 G/90 mm sharp needle, bidirectional barbed PDO cog thread was inserted into subcutaneous tissue. The outcomes of procedure were assessed by Global Aesthetic Improvement Scale (GAIS) and patient satisfaction. Results Thirty-eight patients were included in this study. Mean age of participants was 39.6 ± 7.5 years. The GAIS score showed satisfactory results (very much improved: 78.9%; much improved: 18.4%; improved: 2.6%). According to patient satisfaction, all patients were satisfied with the clinical outcomes of procedure (excellent: 76.3%; very good: 21.0%; good: 2.6%). No patient reported ‘fair’ or ‘poor’ result. Conclusions Our results revealed barbed PDO cog thread is highly effective in facial rejuvenation. Also, tying the PDO threads in same entry point to each other seems to be an effective technique to prevent thread migration.

Effectiveness, Longevity, and Complications of Facelift by Barbed Suture Insertion.

Minimally invasive facelift techniques involving barbed suture insertion have become popular among patients who wish to correct facial tissue ptosis. The authors sought to determine the effectiveness, longevity, complications, and postoperative sequelae associated with facelift by means of barbed polydioxanone (PDO) threads. A total of 160 consecutive patients who underwent facelift with barbed threads were evaluated retrospectively. For malar augmentation and correction of nasolabial grooves, 2 or 3 PDO threads (23 gauge) were placed per side; for treatment of mandibular lines, 2 to 4 PDO threads (21 gauge) were inserted per side. Immediately after suture placement and for 1 month postoperatively, patients experienced improvement in facial tissue ptosis. This aesthetic result declined noticeably by 6 months and was absent by 1 year. The overall complication rate in the early postoperative period was 34% (55 of 160 patients). Eighteen patients (11.2%) had superficial displacement of the barbed sutures, 15 (9.4%) experienced transient erythema, 10 (6.2%) had infection, 10 (6.2%) experienced skin dimpling, and 2 (1.2%) had temporary facial stiffness. Placement of barbed threads yields instantaneous improvement in facial ptosis that is no longer apparent by 1 year. Given this transient benefit and the complication rate of 34%, we recommend limiting this procedure to patients with contraindications for more invasive facial surgery.

In Vivo and In Vitro Anti-Bacterial Efficacy of Absorbable Barbed Polydioxanone Monofilament Tissue Control Device with Triclosan.

This study evaluated the in vitro and in vivo anti-bacterial efficacy of STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Devices in comparison with standard absorbable polydioxanone devices lacking triclosan, utilizing challenges by gram-positive and gram-negative bacteria. The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device was tested for in vitro efficacy against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), S. epidermidis, methicillin-resistant S. epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli using a zone of inhibition (ZOI) assay. The ZOI was used to determine: immediate anti-bacterial efficacy at 24 hours, sustained efficacy for as long as 23 days, and stability for as long as 36 months. Bacterial colonization of the device in vitro was evaluated by scanning electron microscopy and enumerating viable adherent bacteria, expressed as colony-forming units (CFU) per centimeter on the device. In vivo evaluations were conducted in guinea pigs and mice where 3 to 4 cm of the test device and the control suture (commercial Quill™ PDO without triclosan) were implanted subcutaneously through separate catheters into opposite sides of the dorsolateral region. Each implantation site was challenged directly through the indwelling catheter with 106 CFU of S. aureus (guinea pigs) or 107 CFU of E. coli (mice). At 48 hours post-implantation, the test device and control suture were explanted for bacterial enumeration. The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device demonstrated in vitro anti-bacterial activity against all test organisms. This activity was maintained for 11 and 23 days when tested against E. coli and S. aureus, respectively. The device was not colonized by test bacteria in vitro. The anti-bacterial activity remained stable for as long as 36 months of storage at 30°C and 75% relative humidity. In vivo evaluation in animal models demonstrated a 1.16-log reduction in S. aureus and a 1.83-log reduction in E. coli relative to the control device. (p < 0.05) Conclusion: The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device exhibited anti-bacterial efficacy in vitro against a wide range of clinically significant bacterial species with long-lasting inhibition of colonization by S. aureus, and E. coli. It inhibited colonization by S. aureus and E. coli in vitro and in vivo. Thus, the STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device represents a powerful technology to help mitigate one of the risk factors for surgical site infections.

Outcome of Thread Lifting Technique for the Face using Absorbable Barbed Polydioxanone Threads: Innovative Score for Objective and Subjective Assessment

Outcome of Thread Lifting Technique for the Face using Absorbable Barbed Polydioxanone Threads: Innovative Score for Objective and Subjective Assessment

Investigation on the Cutaneous Change Induced by Face-Lifting Monodirectional Barbed Polydioxanone Thread.

Owing to its potentially greater mechanical force on the implanted tissue, barbed thread is frequently used in face-lifting procedures. However, the long-term durability thereof remains controversial. Moreover, reports on underlying histologic and molecular changes resulting from face-lifting procedures are scarce. To evaluate histologic and molecular changes induced by absorbable, barbed face-lifting thread in an animal model. Fragments of monofilament, monodirectionally barbed polydioxanone thread were implanted in dorsal skin from 12 guinea pigs. Tissue samples were harvested at 1, 3, and 7 months thereafter. Histopathologic analysis and quantification of Type 1 collagen and transforming growth factor beta 1 (TGF-β1) levels were performed. Implantation of a single fragment induced fibrous capsule around the thread. Tissue reactions were strongest at 1 month after implantation, showing marked infiltration of inflammatory cells and fibroblasts, which gradually decreased. On molecular analysis, Type 1 collagen and TGF-β1 levels were significantly increased, compared to normal skin, throughout the 7-month study period. Our results suggest that implantation of barbed thread induces strong anchorage to skin tissue. Quantitative analysis of collagen and its downstream signaling molecule TGF-β supports the long-term durability of the thread. Therefore, the authors expect potential beneficial effect for rejuvenation on its clinical application.

New suture materials for midline laparotomy closure: an experimental study.

BackgroundMidline laparotomy closure carries a significant risk of incisional hernia. This study examines the behavior of two new suture materials, an elastic material, polyurethane (PUe), and a barbed polydioxanone (PDXb) suture thread in a rabbit model of midline incision closure.MethodsThree 2-cm midline incisions were made in 68 New Zealand White rabbits. The incisions were closed by running suture using four 3/0 threads: polypropylene (PP) (Surgipro®, Covidien), PUe (Assuplus®, Assut Europe), PDX (Assufil®, Assut Europe) or PDXb (Filbloc®, Assut Europe). Animals in each suture group were euthanized 3 weeks and 6 months after surgery. Histological sections of the tissue-embedded sutures were subjected to morphological, collagen expression, macrophage response and uniaxial tensiometry studies.ResultsNo signs of wound dehiscence or complications were observed. At 3 weeks, all sutures were surrounded by connective tissue composed mainly of collagen III. PUe showed greater collagen I expression than the other sutures. All sutures elicited a macrophage response that diminished from 3 weeks to 6 months (p < 0.001). This response was similar for the non-reabsorbable sutures (PP and PUe) yet PDXb showed a significantly greater response than the other reabsorbable suture (PDX) at 3 weeks (p < 0.01). At this early time point, the tensile strength of PUe was similar to that of control intact tissue (p > 0.05).ConclusionThree weeks after surgery, PUe revealed more collagen I deposition than the remaining materials and this translated to a similar biomechanical behavior to linea alba, that could avoid the appearance of short term dehiscences and thus reduce the incidence of incisional hernia. PDXb provides no additional advantages in their behavior regarding PDX suture.

Short- and long-term biomechanical and morphological study of new suture types in abdominal wall closure

To perform an abdominal-wall closure, a continuous suture is the preferred method. The suture materials that are most commonly employed in abdominal surgery are polypropylene and polydioxanone. However, in recent times, new products have been marketed, such as non-absorbable polyurethane with elastic properties (Assuplus®, Assut Europe, Italy) and absorbable barbed polydioxanone (Filbloc®, Assut Europe, Italy). The purpose of this study was to compare the ability of those against the standard polypropylene (SurgiproTM, Covidien, USA) and polydioxanone (Assufil®, Assut Europe, Italy) to mimic the biomechanical behavior of the abdominal wall closure. Comparison of the sutures was made first with the materials alone and later in a laparotomy closure of a rabbit abdomen, used as an animal model. The biomechanical analysis consisted of uniaxial tensile tests of threads and sutured samples of the animal abdomen. In the latter case, results were analyzed at short- (21days) and long- (180days) term intervals after the surgery. The morphology studies and collagen expression of the samples were also investigated.The results determined that polydioxanone and polypropylene sutures showed a linear elastic behavior, with barbed polydioxanone as the most compliant suture and polyurethane as the stiffest. The sutured samples showed a statistically significant loss of resistance, measured as the load needed to perform a certain stretch, when compared with the corresponding control tissue. Analysis of the stress–stretch curves showed that elastic polyurethane was the only suture able to reproduce the mechanical behavior of healthy tissue in the short term, while the rest of the sutures remained less stiff. This coincides with the expression of type I collagen observed in this group at this point in the study. In the long term, there was no difference among the sutures, and none was able to mimic control behavior.

Transvesical approach laparoendoscopic single-site radical prostatectomy: for organ-confined prostate cancer: report of 8 cases

Objective To investigate the feasibility of applying transvescal approach laparoendoscopic single-site radical prostatectomy (TVSSLRP) and assess the oncological and functional outcomes.Methods Eight patients with clinically localized prostate cancer (PCa) of low risk underwent TVSSLRP.Demographic data were accrued including patient age,body mass index (BMI),preoperative PSA level,the International Index of Erectile Function 5,biopsy Gleason score,clinical TNM stage and D'Amico risk classification.One surgeon performed all TVSSLRP procedures.A homemade triple-port was introduced percutaneouly into the bladder to establish pneumovesicum through a 4 cm incision.The major steps of the surgery were described as follows:initial incision was made along posterior margin of the bladder neck to expose bilateral vas deference and spermatic vesicle.After opening Denonvilliers' fascia and extending the space to lateral prostatic pedicles,an intra-fascial nerve sparing procedure was performed.The puboprastatic ligaments were then separated close to the prostate surface and the dorsal vein complex was cautiously swept off.Subsequently,careful apical dissection and urethral transection was sequentially conducted. To reduce the tension of vesico-urethral anastomosis,3 additional incisions parallel to vesio-urethral margin were created and a novel tension - reduced V-LocTM barbed polydioxanone sutures was used. Results All the operations were successfully performed and there was no conversion to standard laparoscopic approach or open surgery.The total operative time range was 75 - 180 min with mean time of 125 min.The blood loss was 85 -450 ml with mean 140 ml and no blood transfusion was required.The catheter was removed after a mean (range) of 14 (9 -16) days.No intra-operative complications occurred. No patient had positive surgical margins.The mean (range) hospital stay was 17 (13 -25) days after surgery. All the cases were continent after removal of the catheter.No cases demonstrated vesico-urethral stricture and biochemical recurrence on 12 - 18 months follow up postoperatively. Conclusions TVSSLRP is technically feasible for cases with organ-confined prostate cancer with good oncological and functional results. Key words: Laparoscope; Prostate cancer; Radical prostatectomy; Transvesical; Laparoendoscopic single-site

A comparison of barbed and smooth sutures for ovine cesarean delivery

Objective To determine the adequacy of barbed and smooth sutures for closing the uterus and fascia in pregnant ewes. Methods Nine ewes that underwent cesarean delivery were randomized to each receive 2 different suture materials for both the uterus and the fascia. The sutures used were: barbed poliglecaprone 25, smooth poliglecaprone 25, braided polyglactin 910, and smooth chromic sutures on the uterus; and barbed polydioxanone (PDO), barbed poliglecaprone 25, braided polyglactin 910, and smooth chromic sutures on the fascia. Results In 4 of the ewes, the fascia suture line failed prematurely, leading to dehiscence prior to planned euthanasia and necropsy. The remaining 5 ewes were euthanized on days 2, 7, or 28. All suture materials (smooth and barbed) were adequate for uterine closures. Barbed PDO, smooth poliglecaprone 25, and braided polyglactin 910 were adequate for fascia closures, whereas both barbed poliglecaprone 25 and smooth chromic resulted in premature suture line ruptures and fascia dehiscence. Conclusion In a small pilot study, absorbable knotless barbed suture was adequate and equivalent to absorbable knotted smooth suture for closing the uterus following ovine cesarean delivery. On the rectus fascia, however, sutures—whether barbed or smooth—with lower tensile strength resulted in fascial dehiscence.

Knotless Closure of the Collecting System and Renal Parenchyma with a Novel Barbed Suture During Laparoscopic Porcine Partial Nephrectomy

Closure of the urinary collecting system and renal parenchyma is a technically challenging aspect of laparoscopic nephron-sparing surgery and an obstacle to its more widespread use. A novel barbed polydioxanone suture material Quill self-retaining suture (SRS) (Angiotech Pharmaceuticals) has been introduced for knot-free tissue approximation. We compared the outcomes of Quill SRS versus a conventional technique for kidney and collecting system closure during laparoscopic porcine partial nephrectomy. After approval of the Institutional Animal Care and Use Committee, 10 female pigs underwent bilateral transperitoneal laparoscopic lower pole heminephrectomy. Closure of the collecting system and approximation of the renal parenchyma was performed in two layers using continuous knotless barbed suture for one kidney (Quill SRS) and polyglactin (Vicryl) with absorbable polydioxanone clips (LapraTy; Ethicon) on the contralateral kidney. For both techniques, the collecting system was closed with 2-0 suture and renal parenchyma with #1 suture. Warm ischemia and suturing time were recorded, and resected tissue was weighed. All animals were sacrificed 1 week after surgery. Serum hemoglobin and visual inspection at necropsy were used to assess for bleeding; visual inspection of the peritoneum and bilateral retrograde pyelography were used to assess for urinary fistula. Mean (+/-standard deviation [SD]) weight of resected tissue (barbed, 34 +/- 13 g; clips, 34 +/- 11 g; p = 0.6), mean (+/-SD) ischemia time (barbed, 34 +/- 8 minutes; clips, 34 +/- 10 minutes; p = 0.7), and mean (+/-SD) suturing time (barbed, 21 +/- 4 minutes; clips, 22 +/- 7 minutes; p = 0.7) were similar between groups. No animal had a visible hematoma or urinoma at necropsy. On retrograde pyelography, a small urinary leak was found in two kidneys in each group (p = 0.6). In a porcine laparoscopic partial nephrectomy model, it appears that knotless barbed suture is as effective, efficient, and safe as a conventional technique. Further evaluation in humans is warranted and required.

KNOTLESS CLOSURE OF COLLECTING SYSTEM AND RENAL PARENCHYMA WITH A NOVEL BARBED SUTURE DURING LAPAROSCOPIC PARTIAL NEPHRECTOMY

Abstract Introduction: Closure of the urinary collecting system and renal parenchyma is a technically challenging aspect of laparoscopic nephron-sparing surgery and an obstacle to its more widespread use. A novel barbed polydioxanone suture material Quill™ self-retaining suture (SRS) (Angiotech Pharmaceuticals©) has been introduced for knot-free tissue approximation. We compared the outcomes of Quill SRS versus a conventional technique for kidney and collecting system closure during laparoscopic porcine partial nephrectomy. Methods: After approval of the Institutional Animal Care and Use Committee, 10 female pigs underwent bilateral transperitoneal laparoscopic lower pole heminephrectomy. Closure of the collecting system and approximation of the renal parenchyma was performed in two layers using continuous knotless barbed suture for one kidney (Quill SRS) and polyglactin (Vicryl™) with absorbable polydioxanone clips (LapraTy™; Ethicon) on the contralateral kidney. For both techniques, the collecting syste...