Chromic Catgut Sutures Research Articles

Comparison of different absorbable suture materials in skin closure: An experimental study in rats

Aim: The purpose of this study was to compare polydioxanone (PDS), polyglycolic acid (Dexon), polyglactin 910 (Vicryl) and chromic catgut suture materials for closure of skin incision in rats. Material and method: Thirty-six Sprague-Dawley male rats were used. Two centimetre skin incisions were made in each rat and were closed using randomly assigned PDS, Vicryl, Dexon or chromic catgut. On the 7th, 14th and 28th days, skin incisions were evaluated for dehiscence, oedema and infection. Histopathological cross-sections from the skin incision sites were examined under light microscope. Results: The macroscopic appearance of all specimens was not statistically different. The statistical difference in mean scores of most of the histopathological variables between suture materials was not significant. Only on the 7th day were fibrosis scores of Vicryl, Dexon and PDS statistically different from those of catgut (p < 0.01). The score for tissue inflammatory reaction near Vicryl was higher than for the others on the 7th and 14th days but this difference was not statistically significant. summary

Stability of neuropathic pain symptoms in partial sciatic nerve ligation in rats is affected by suture material

Many factors affect the development of neuropathic pain behavior in animal models. In this letter, we describe the differences in the development of neuropathic pain behavior observed when the partial sciatic nerve ligation (PNL) is performed with either a synthetic silk or chromic catgut ligation. To characterize nociceptive changes over time after surgery, neutral plate, hot plate, Von Frey, pinprick, acetone spray and cold plate testing was performed. The results indicated that a chromic catgut ligature caused cold allodynia, chemical hyperreactivity, mechanical hyperalgesia and hypersensitivity that remained present for the entire 56 days post-surgical observation period. With the synthetic silk ligature, comparable functional deficits were present in the initial phase after surgery, but several of these deficits diminished over time 21–28 days post-surgery. In conclusion, performing the PNL using chromic catgut suture thread gives rise to more robust sensory deficits than when synthetic silk is used. Therefore, the material that is used for the ligature in the partial sciatic ligation model has an effect on the outcome of the observed sensory abnormalities.

Fibrin glue for the suture-less correction of penile chordee: a pilot study in a rabbit model.

To evaluate the use of fibrin glue as a scaffold for patching defects in the tunica albuginea in a rabbit model for a future application in correcting chordee. Nine New Zealand white male rabbits were utilized. All had a 15 x 5-mm defect created in the ventral tunica albuginea. Fibrin glue (1 mL) was applied to cover the defect in tunica albuginea and the penile skin closed with a continuous 5/0 chromic catgut suture. Animals were killed in groups of three at 2, 6 and 12 weeks afterward. The evaluation included an artificial erection test with intracavernosal injection of prostaglandin E1 (5 microg), cavernosography and histopathological examination of sections of the penis stained with haematoxylin and eosin or Masson trichrome. None of the rabbits died during the procedure or developed bleeding or haematoma afterward. All animals had straight erections on testing with prostaglandin (5 microg). There was no evidence of corporal narrowing or venous leakage on cavernosography. Histopathological evaluation showed evidence of the fibrin sealant layer, with angiogenesis and a cell infiltrate at 2 weeks. At 6 and 12 weeks there was completely normal regeneration of the tunica albuginea. In this pilot study in a rabbit model the haemostatic effect of fibrin glue was confirmed on covering a defect in the tunica albuginea. Moreover, there was regeneration of normal tunica albuginea with no scarring at 6 weeks and maintained at 12 weeks. Further well-controlled studies are required before using fibrin glue for corporal body grafting to treat chordee.

Effect of human pancreatic juice and bile on the tensile strength of suture materials

Background Several suture materials are used for pancreatojejunal anastomosis. In this study, we tested the durability of these suture materials in human pancreatic juice and bile. Methods Plain and chromic catgut, polyglactin 910, polyglycolic acid, polydioxanone, polypropylene, and silk sutures were incubated in pancreatic juice and bile that was collected from patients. Fifteen samples of each type of suture material were placed in human juices for 1, 3, and 7 days. Tensile strengths were measured with a tensionmeter. Results Plain and chromic catgut disintegrated in pancreatic juice and pancreatic juice plus bile mixture. Polyglycolic acid and polyglactin 910 suture materials were vulnerable to pancreatic juice within 7 days. Polydioxanone retained most of its initial strength in pancreatic juice and bile. Polypropylene and silk retained 84% and 92% of their initial strength, respectively. Conclusions We found that polidioxanone was the strongest suture material in pancreatic juice.

Deep Sclerectomy with Various Implants: An Experimental and Histopathologic Study in a Rabbit Model

Background and Objective: To investigate the effectiveness of various implants used in experimental deep sclerectomy and to report tissue reactions developed to these implants histopathologically. Materials and Methods: Forty eyes of 40 New Zealand white albino rabbits underwent deep sclerectomy with various implants. The rabbits were divided into four groups; each consisted of 10 eyes. Deep sclerectomy was performed using copolymer materials in group 1, silicone materials in group 2 and chromic catgut suture in group 3. No implants were used in the control group (group 4). Clinical and histopathological examinations were performed to investigate the effectiveness of implants. Results: Mean preoperative intraocular pressure (IOP) was 14.4 ± 1.6 mm Hg in group 1, 14.5 ± 1.8 mm Hg in group 2, 13.8 ± 1.5 mm Hg in group 3 and 14.5 ± 1.2 mm Hg in group 4. The final postoperative IOPs were 10.7 ± 0.9, 10.6 ± 0.8, 13.5 ± 1.0, and 14.5 ± 1.4 mm Hg, respectively. At 2 months, the decrease in IOPs from baseline and the persistence of the filtering bleb were significantly marked in group 1 and group 2 (p < 0.001). Histopathological evaluation revealed that copolymer and silicone materials formed a smooth and regular intrascleral space. There were no foreign body reaction, tissue destruction or fibrosis in group 1 and group 2, but chromic catgut sutures caused severe fibrosis and inflammatory reaction in group 3. Mean histopathologic score of group 1, group 2, group 3 and group 4 was 0.7 ± 0.5, 0.8 ± 0.5, 2.4 ± 0.6, and 0.1 ± 0.3, respectively. Conclusion: Copolymer or silicone materials may increase the success rate of surgery by maintenance of a large and regular intrascleral space after deep sclerectomy and prevention of collapse of the flap.

SELECTED COCHRANE SYSTEMATIC REVIEWS Absorbable Synthetic Versus Catgut Suture Material for Perineal Repair

A substantive amendment to this systematic review was last made on 19 May 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background and objectives: Approximately 70% of women will experience some degree of perineal trauma following vaginal delivery and will require stitches. This may result in perineal pain and superficial dyspareunia. The objective of this review was to assess the effects of absorbable synthetic suture material as compared with catgut on the amount of short- and long-term pain experienced by mothers following perineal repair. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register. Selection criteria: Randomised trials comparing absorbable synthetic (polyglycolic acid and polyglactin) with plain or chromic catgut suture for perineal repair in mothers after vaginal delivery. Data collection and analysis: Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer. Main results: Eight trials were included. Compared with catgut, the polyglycolic acid and polyglactin groups were associated with less pain in first three days (odds ratio 0.62, 95% confidence interval 0.54–0.71). There was also less need for analgesia (odds ratio 0,63, 95% confidence interval 0.52–0.77) and less suture dehiscence (odds ratio 0.45, 95% confidence interval 0.29–0.70). There was no significant difference in long-term pain (odds ratio 0.81, 95% confidence interval 0.61–1.08). Removal of suture material was significantly more common in the polyglycolic acid and polyglactin groups (odds ratio 2.01, 95% confidence interval 1.56–2.58). There was no difference in the amount of dyspareunia experienced by women. Reviewers' conclusions: Absorbable synthetic suture material (in the form of polyglycolic acid and polyglactin sutures) for perineal repair following childbirth appears to decrease women's experience of short-term pain. The length of time taken for the synthetic material to be absorbed is of concern. A trial addressing the use of polyglactin has recently been completed and this has been included in this updated review. Citation: Kettle C, Johanson RB. Absorbable synthetic versus catgut suture material for perineal repair (Cochrane Review). In: The Cochrane Library, Issue 4, 1999, Oxford: Update Software. ••• The preceding report is an abstract of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full texts of the reviews are available in The Cochrane Library (ISSN 1464-780X). See http://www.update-software.com/cochrane.htm or contact Update Software, info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom (Tel.: +44 1865 513902; Fax: +44 1865 516918).

Absorbable synthetic versus catgut suture material for perineal repair.

Approximately 70% of women will experience some degree of perineal trauma following vaginal delivery and will require stitches. This may result in perineal pain and superficial dyspareunia. The objective of this review was to assess the effects of absorbable synthetic suture material as compared with catgut on the amount of short and long term pain experienced by mothers following perineal repair. We searched the Cochrane Pregnancy and Childbirth Group trials register. Randomised trials comparing absorbable synthetic (polyglycolic acid and polyglactin) with plain or chromic catgut suture for perineal repair in mothers after vaginal delivery. Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer. Eight trials were included. Compared with catgut, the polyglycolic acid and polyglactin groups were associated with less pain in first three days (odds ratio 0.62, 95% confidence interval 0.54 to 0.71). There was also less need for analgesia (odds ratio 0.63, 95% confidence interval 0.52 to 0.77) and less suture dehiscence (odds ratio 0.45, 95% confidence interval 0.29 to 0.70). There was no significant difference in long term pain (odds ratio 0.81, 95% confidence interval 0.61 to 1.08). Removal of suture material was significantly more common in the polyglycolic acid and polyglactin groups (odds ratio 2.01, 95% confidence interval 1.56 to 2.58). There was no difference in the amount of dyspareunia experienced by women. Absorbable synthetic suture material (in the form of polyglycolic acid and polyglactin sutures) for perineal repair following childbirth appears to decrease women's experience of short-term pain. The length of time taken for the synthetic material to be absorbed is of concern. A trial addressing the use of polyglactin has recently been completed and this has been included in this updated review.

Aderências peritoneais em eqüinos: tratamento profilático com carboximetilcelulose

As aderências peritoneais formam-se freqüentemente nos eqüinos submetidos a laparotomia. As aderências podem ser assintomáticas ou podem causar complicações como cólica e osbstrução intestinal, às vezes com estrangulamento vascular. Com o objetivo de avaliar a eficiência do uso intraperitoneal de carboximetilcelulose (CMC) na prevenção de aderências peritoneais em eqüinos, fez-se o seguinte experimento: dezoito eqüinos clinicamente normais, sem raça definida (SRD), foram anestesiados e submetidos a laparotomia na linha mediana ventral, quando se produziu lesões no jejuno distal para induzir a formação de aderências peritoneais. Em quatro animais (bloco I) foram criadas seis lesões: um segmento com aproximadamente 45cm de comprimento foi submetido à isquemia, através da ligadura da circulação mural e dos vasos mesentéricos por duas horas; em cinco pequenas áreas, com cerca de três por cinco centímetros, foi feita abrasão da serosa pela fricção 100 vezes de uma gaze seca e um ponto simples seromuscular de categute cromado foi aplicado no seu centro. Nos outros 14 animais (bloco II). o modelo adotado foi semelhante com pequenas modificações: ao invés de um segmento de isquemia foram criados quatro segmentos com 25cm de comprimento; a abrasão das cinco pequenas áreas foi feita com uma pinça Rochester aberta e não com uma gaze seca; a sutura seromuscular com categute aplicada no centro das áreas de abrasão foi uma linha contínua simples, com aproximadamente 2,5cm de comprimento e não um ponto simples. Os animais foram aleatoriamente divididos em dois grupos. Em dois animais do bloco I e sete animais do bloco II (grupo tratamento), antes da síntese da parede abdominal, foi instilada, na cavidade peritoneal, uma solução decmC a 7% na dose de 7 ml/kg. Nos outros nove animais (grupo controle) a parede foi suturada da mesma forma, mas nenhum medicamento foi aplicado na cavidade peritoneal. Os eqüinos foram examinados diariamente. Quatorze dias após a cirurgia, todos os animais sofreram eutanásia e foram submetidos à necropsia. Seis, dentre os nove animais do grupo controle e quatro, dentre os nove animais do grupo tratamento, desenvolveram aderências perítoneais. Não houve diferença significativa entre o número de animais com aderências nem entre o número ou o grau das aderências formadas nos dois grupos. Os animais do grupo tratamento não apresentaram qualquer sinal de toxicidade ou hipersensibilidade àcmC. Concluiu-se que a carboximetilcelulose não foi eficiente na prevenção de aderências peritoneais no intestino delgado de eqüinos induzidas por abrasão da serosa e isquemia. Concluiu-se também que esta droga não causou efeitos colaterais e não prejudicou a cicatrização do peritônio.

The Ipswich Childbirth Study: 2. A randomised comparison of polyglactin 910 with chromic catgut for postpartum perineal repair

To compare polyglactin 910 sutures with chromic catgut sutures for postpartum perineal repair. A stratified randomised controlled trial, using a 2 x 2 factorial design. The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994. 1780 women who had sustained an episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery. Policies of repair with polyglactin 910 or chromic catgut were compared. Both groups were assessed by a research midwife completing questionnaires at 24 to 48 hours and at ten days postpartum, and by self-completed questionnaires at three months after birth. 1. 24 to 48 hours postpartum: perineal pain, healing; 2. ten days postpartum: perineal pain, healing and removal of sutures; 3. three months postpartum: perineal pain, removal of sutures, resuturing, dyspareunia, and failure to resume pain-free intercourse. Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. The two groups were similar at trial entry. Significantly fewer women allocated to the polyglactin 910 reported pain in the previous 24 hours at both 24 to 48 hours (59% vs 67%; RR 0.89, 95% CI 0.83-0.95; 2P < 0.01), and ten days (24% vs 29%; RR 0.81, 95% CI 0.69-0.95; 2P = 0.01). At three months postpartum there was no clear difference between the groups in terms of perineal pain, dyspareunia or failure to resume pain-free intercourse. More women in the polyglactin 910 group reported that some suture material had been removed (12% vs 7%; RR 1.62, 95% CI 1.19-2.21; 2P < 0.01). Three women in the polyglactin 910 group had required resuturing compared with ten in the chromic catgut group (RR 0.30; 95% CI 0.08-1.09; 2P = 0.1). Using polyglactin 910 rather than chromic catgut for perineal repair leads to about one fewer women among every 20 having perineal pain and using analgesia ten days postpartum. Its only apparent disadvantage is that more women, again estimated as 1 in 20, report having material removed during healing. Data from this and other trials suggest that for every 100 women repaired with a polyglycolic acid-based material, about one fewer will require resuturing.

Comparison of effects of suture materials on wound healing in a rabbit pyeloplasty model

Objectives To compare the effects of chromic catgut, polyglactic acid, polydioxanone (PDS), and polytrimethylene carbonate suture on urothelial healing in a rabbit model simulating pyeloplasty. Methods Pyeloureterotomies were performed on 8-week-old rabbits [12 rabbits (24 renal units) and 3 control rabbits] and closed with interrupted 7-0 sutures. At 10 days, 5 weeks, and 12 weeks postoperatively, we assessed the upper tracts by examining microscopic sections of the renal pelvis and upper ureter. Acute and chronic inflammation, foreign body reaction, and fibrosis/scar formation were assessed blindly and scored from 0 to 4. Results Histologic evidence of acute and chronic inflammation and foreign body reaction was most severe at 10 days and 5 weeks in pyeloureterotomies closed with chromic catgut. There was mild inflammation in those closed with polyglactic acid at 10 days, but it was minimal in those closed with polyglactic acid, PDS, and polytrimethylene carbonate at 5 and 12 weeks. Reabsorption of polyglactic acid was complete by 5 weeks, but was incomplete with the other three sutures at that time. By 12 weeks, there was persistent suture in 50% of the renal units closed with polydioxanone and in 100% of those closed with polytrimethylene carbonate. No animal developed a renal calculus. Conclusions Because of the mild inflammatory response and rapid tissue reabsorption of polyglactic acid in this animal model, this suture appears to be the best suture for pyeloplasty.

Comparison of the degree of abdominal adhesion formation associated with chromic catgut and polypropylene suture materials

Abstract Objective To evaluate the histologic pattern and biomechanical properties of adhesions caused by chromic catgut and polypropylene sutures, using an enteropexy model. Design Enteropexies were created in dogs, using chromic catgut and polypropylene suture. The adhesions associated with the enteropexies were examined histologically and mechanically. Animals 6 mixed-breed dogs weighing 16 to 20 kg. Procedure 72 enteropexies were created between the jejunum and abdominal wall. 36 sites were sutured with chromic catgut, and 36 were sutured with polypropylene. 3 dogs were euthanatized after 1 week. The remaining dogs were euthanatized after 1 month. Samples of the enteropexy sites were obtained for histologic examination. The remaining sites were mechanically distracted until failure of the enteropexy site or adjacent tissue occurred. Results Histologic examination of the enteropexy sites did not reveal substantial differences in the degree of inflammation between the 2 suture types at 1 week or 1 month. The degree of inflammation decreased and the maturity of fibrous tissue formed at the enteropexy sites increased for all specimens over time. No statistically significant difference in breaking strength was observed between suture types at 1 week or 1 month. Conclusion In dogs, the formation and strength of intentionally created abdominal adhesions are not increased by use of chromic catgut. Clinical Relevance Selection of chromic catgut suture for use in surgical procedures where adhesions are desired is unwarranted. (Am J Vet Res 1996;57:943–947)

HYPOSPADIAS: RESULTS OF TREATMENT IN 18 YEARS OF PAEDIATRIC SURGICAL PRACTICE

This is a review of hypospadias surgery in a provincial surgical practice over 18 years. A total of 347 boys were seen with hypospadias, of whom 209 were operated upon. These operations consisted of 69 Durham Smith de-epithelialized double-breasting two-stage procedures, 45 meatal advancement and glanuloplasty procedures, 27 hemi-circumcisions with or without meatotomy, 24 single stage repairs for distal hypospadias without chordee, 23 operations for chordee without hypospadias, 15 modified Mathieu single stage procedures and six miscellaneous procedures. The complication rate, particularly for fistulae formation in 17%, was unacceptably high. Some causes of fistulae were identified; these included delayed absorption of chromic catgut sutures and stitch abscess. Stricture occurred less frequently, but one case was severe enough to require complete revision of the urethroplasty. In early operations a coronal meatus was the norm and six patients required advancement procedures.

Influence of soluble suture factors on in vitro macrophage function

Suture materials may interact with immune competent cells and thereby affect localized immunity. Macrophages are central to the inflammatory response and coordinate wound healing. They are also involved in the clearance of foreign material, bacteria and malignant cells. We studied the influence of soluble factors associated with silk, steel, nylon, polyglactin, polydioxanone and chromic catgut sutures on macrophage adherence, phagocytosis and the production of lysozyme and tumour necrosis factor. Soluble factors from suture materials influenced macrophage behaviour in vitro causing cellular activation, functional impairment and alterations in secreted levels of the cytokine tumour necrosis factor and the bactericidal agent lysozyme. Of the six materials studied, polyglactin had the most extreme effect, causing significant inhibition of cell adherence and lysozyme production. Silk also exerted a considerable effect on macrophages, significantly inhibiting adherence. In contrast, steel and polydioxanone media caused minimal inhibition of macrophage function although, as with all materials, they did activate the cells. This study has demonstrated that sutures release immunotoxic factors which considerably influence macrophage behaviour in vitro. These effects may have important clinical implications.

Intraluminal bypass technique using a condom for protection of coloanal anastomosis.

Most surgeons carry out temporary diverting colostomy in coloanal anastomosis for mid-rectal or lower-rectal carcinomas. It has been reported that proximal fecal diversion provides no guarantee against anastomotic leaks. Some have proposed the use of the intracolonic bypass tube to prevent anastomotic leakage and colostomy, but colonic necrosis has been reported; it is important to use a safe technique that obviates this. The rectum is fully mobilized and transected at the level of the levator diaphragm. The mobilized sigmoid and rectum are resected with their mesenteries, and the prepared distal colon is everted 5 cm using Babcock clamps. The ring of a sterilized condom is then sutured to the mucosa and submucosa of the colon with 4/0 chromic catgut sutures. After completion of coloanal anastomosis, the condom is brought to the exterior, and the mid part is transected. We have used a condom for intraluminal bypass procedures in ten rectal carcinoma patients including five preoperative radiation cases. There was no anastomotic dehiscence, leakage, or colonic necrosis because of a condom. We believe that the intraluminal bypass technique using a condom is a very safe, cost-effective, and easily available alternative for coloanal anastomosis.

490 Comparison of Postpartum Pain and Healing with Repair of Perineal Disruptions Using Chromic Catgut or Polyglycolic Acid Suture

490 Comparison of Postpartum Pain and Healing with Repair of Perineal Disruptions Using Chromic Catgut or Polyglycolic Acid Suture

Stimulation of regeneration of the sciatic nerve by experimentally induced inflammation in rats.

The effects of application of a chromic catgut suture (conditioning lesion) placed close to the sciatic or tibial nerves on regeneration of the sciatic nerve after a crush lesion (test lesion), that had been induced after an appropriate conditioning interval (two or four weeks) were assessed. The catgut suture induced an inflammatory reaction around the nerve during the four weeks after application of the catgut suture (conditioning interval) but no signs of degeneration of nerve fibres were seen. There was a significant increase in length of outgrowth of sensory nerve fibres as measured by the pinch reflex test when the test lesion was applied after two and four weeks' exposure to the catgut suture. The rate of regeneration was increased by about 11% when the catgut suture had been applied for four weeks before the test lesion was made. The findings indicate that an inflammatory reaction around a peripheral nerve may act as a conditioning lesion, thereby stimulating regeneration of the nerve.

Suture Material in Bladder Surgery a Comparison of Polydioxanone, Polyglactin, and Chromic Catgut

A comparison of polydioxanone, polyglactin, and chromic catgut suture was performed in 120 rat bladders studying propensity for infection, degree of inflammation, calculogenic potential, changes in urine pH, and suture absorption. None of the sutures predisposed to infection and there was wide variability but no correlation in urine pH. Although initially the polydioxanone incited a greater inflammatory response, by six months all three sutures were similar. The absorption of polydioxanone was slower than chromic catgut suture, but similar to the absorption of polyglactin. There was no significant difference in calculogenic potential between the suture materials tested over a six-month period. Based on this study in rats, polydioxanone suture would appear to be equal to catgut and polyglactin suture in bladder surgery. (J. Urol, 143: 1261–1263, 1990)

Chromic catgut suture should be abandoned for fascial closure of the anterior abdominal wall in favor of newer, stronger delayed absorbable suture materials. Con.

Chromic catgut suture should be abandoned for fascial closure of the anterior abdominal wall in favor of newer, stronger delayed absorbable suture materials. Con.

Chromic catgut suture should be abandoned for fascial closure of the anterior abdominal wall in favor of newer, stronger delayed absorbable suture materials. Pro.

Chromic catgut suture should be abandoned for fascial closure of the anterior abdominal wall in favor of newer, stronger delayed absorbable suture materials. Pro.

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.