Suture Material Research Articles

Pilot study about the use of alternative materials to teach surgical skills to medical students: a cross-sectional observational study

Introduction: Suturing is an important surgical procedure in which tissue margins are joined after incision or laceration, it is a fundamental medical skill and requires extensive practice to improvement, especially during the medical educational process. In the Basic Surgical Skills Course training suture is one of the foundations to learn hospital procedure techniques, that are essential during the routine of a medical professional. Objective: This study aims to evaluate the capability that EVA, eggplant, elastic tape, and chicken thigh must mimic basic surgical scenarios and replace expensive materials during the medical education of undergraduates and the development of the skills needed as future health professionals. Methods: This is a cross-sectional descriptive observational study, which evaluated students during the surgical skills class to perform suture practice on materials such as EVA, eggplant, elastic tape, and chicken thigh. Results: The materials were evaluated as useful components for training suturing practice. However, eggplant, and elastic tape were considered superior materials. Furthermore, practicality of use correlated with greater instrumental knowledge. Conclusions: The use of alternative materials for training surgical sutures is more accessible because of the low cost, however the results represent a prototype of an analysis that requires an expansion in the number of samples to better determine the cause-effect conditions.

SUTURE TECHNIQUES AND MATERIALS FOR FASCIAL CLOSURE OF ABDOMINAL WALL INCISIONS: HOW DO THEY COMPARE IN A SYSTEMATIC REVIEW AND META-ANALYSIS?

Abstract Background The aim of this meta-analysis was to evaluate closure of laparotomy using different suture-materials and techniques. Methods A literature search was conducted till 11 October 2023. All randomized controlled trials (RCTs) and prospective cohort studies (PCSs) on laparotomy closure were included. The study quality was evaluated using the ROB2 and ROBINS-I checklists. The primary outcome was incisional hernia (IH), and secondary outcomes were fascial dehiscence (FD), combined-FD+IH, and surgical site infection (SSI). Meta-analyses were performed using random-effects models. Results A total of 73 RCTs and 26 PCSs were included. Slowly-absorbable suture materials were associated with a lower risk of IH (OR: 0.64; 95%CI: 0.47–0.86) and combined-FD+IH (OR: 0.76; 95%CI: 0.58–0.99) when compared to fast-absorbable sutures (5 studies, 2,262 patients). Non-absorbable suture material was not superior to any other suture material. Continuous-suturing was not superior to interrupted-suturing, neither was mass-closure superior to layered-closure for any of the outcomes. Small-bites technique with a slowly-resorbable suture in the elective-setting resulted in significantly less IHs (OR 0.42; 95%CI: 0.28–0.62), combined-FD+IH (OR 0.39; 95%CI: 0.22–0.72) and SSIs (OR 0.67; 95%CI: 0.52–0.83) compared to a large-bites technique (8 studies, 1,168 patients). In the emergency setting, the continuous Smead-Jones suturing significantly reduced the risks of IH (OR 0.22; 95%CI: 0.08–0.59), FD (OR 0.20; 95%CI: 0.11–0.34), combined-FD+IH (OR 0.08; 95%CI: 0.03–0.19), and SSI (OR 0.45; 95%CI: 0.26–0.79) compared to continuous-suturing (6 studies, 265 patients). Conclusions Closure of laparotomies using the small-bites technique is superior to large-bites techniques. In the emergency setting, the Smead-Jones technique seems a valid alternative.

Biomechanical comparison of bone staple fixation methods with suture material for median sternotomy closure using 3D-printed bone models

ABSTRACT Aim To compare the biomechanical properties of three different sternal closure techniques in a 3D-printed bone model of a sternum from a 30-kg dog. Methods Median sternotomy was performed on a total of 90 three-dimensional (3D) copies of a polycarbonate (PC) model of a sternum, generated from the CT images of the sternum of a 30-kg German Shepherd dog. Three different methods were used to repair the sternotomies: polydioxanone suture (group PDS, n = 30), stainless steel bone staples (group SS, n = 30), and nitinol bone staples (group NS, n = 30). Each repair method was tested by applying tensile force in one of three ways (longitudinally, laterally, or torsionally) resulting in a sample size of n = 10 for each repair method-loading combination. In all experiments, the loads at 1-mm and 2-mm gap formation, failure, and the displacement at the failure point were measured. Results In lateral distraction and longitudinal shear tests, NS and SS staple repairs required application of significantly greater force than PDS across all displacement criteria (1 and 2 mm). NS exhibited significantly greater failure load than PDS. In torsion tests, NS required significantly greater application of force compared to SS or PDS at all displacement criteria (1 and 2 mm) and exhibited a greater failure load than PDS. In terms of displacement at failure point, PDS suture showed more displacement than SS or NS across all experiments (laterally, longitudinally, torsionally). Conclusions In this study, bone staples were mechanically superior to PDS suture in median sternotomy closure using 3D-printed bone model in terms of 1-mm, 2-mm displacement loads, and displacement at failure. NS had a higher failure load than PDS under lateral, longitudinal, and torsional distraction. Clinical relevance These study results imply that bone staples can be considered as an alternative surgical method for median sternotomy closure in dogs.

Nylons with Applications in Energy Generators, 3D Printing and Biomedicine.

Linear polyamides, known as nylons, are a class of synthetic polymers with a wide range of applications due to their outstanding properties, such as chemical and thermal resistance or mechanical strength. These polymers have been used in various fields: from common and domestic applications, such as socks and fishing nets, to industrial gears or water purification membranes. By their durability, flexibility and wear resistance, nylons are now being used in addictive manufacturing technology as a good material choice to produce sophisticated devices with precise and complex geometric shapes. Furthermore, the emergence of triboelectric nanogenerators and the development of biomaterials have highlighted the versatility and utility of these materials. Due to their ability to enhance triboelectric performance and the range of applications, nylons show a potential use as tribo-positive materials. Because of the easy control of their shape, they can be subsequently integrated into nanogenerators. The use of nylons has also extended into the field of biomaterials, where their biocompatibility, mechanical strength and versatility have paved the way for groundbreaking advances in medical devices as dental implants, catheters and non-absorbable surgical sutures. By means of 3D bioprinting, nylons have been used to develop scaffolds, joint implants and drug carriers with tailored properties for various biomedical applications. The present paper aims to collect evidence of these recently specific applications of nylons by reviewing the literature produced in recent decades, with a special focus on the newer technologies in the field of energy harvesting and biomedicine.

Absorbable vs. non-absorbable suture: which one gives better results?

There is no ideal suture material or ideal sewing technique. The type of suture material affects the quality of the scars. Patient and surgeon satisfaction with the quality and comfort of the scar is one of the main goals of modern surgery. This study aims to compare the quality of scars and patient satisfaction after using two different types of sutures. This research was conducted as a prospective study that included 64 patients whose surgical wounds were closed with intradermal suture using different suturing materials according to which the patients were divided into two groups: absorbable - Monocryle (32) and non-absorbable - DemeLENE suture (32). POSAS scale and an ultrasound machine were used to assess the scars. The doctor and the patient evaluated seven parameters on two occasions, after 2 and 6weeks after the surgery. The statistically significant advantage was found after 2weeks in scars sewn with non-resorptive suture in terms of elasticity, doctor's general impression, pain, itching, color, stiffness, thickness, irregularity, and patient's general impression. After 6weeks, statistically significantly better results were shown on scars sewn with non-resorptive thread for the parameters doctor's general impression, itching, irregularity, and patient's general impression. Non-resorptive sutures show statistically significantly better results, especially after 2weeks from the patient's point of view so we consider them more comfortable and convenient to use.

Bioactive coatings on biopolymer materials: evaluation of mechanical, physical, thermal, and in vitro properties

The aim of this study was to develop and characterize coatings of bioglass nanoparticles (BGNs) on biopolymer (poly [glycolide-co-L-lactide], (PGLA)) surgical sutures, and to investigate the effects of these coatings on the performance of the sutures as they slid through a skin substitute. Melt-derived BGNs were used to coat resorbable PGLA biopolymers, providing them with bioactivity, biocompatibility, and improved physical and mechanical properties. The structural, thermal, and physical properties of the coated and uncoated biopolymers were analyzed using Differential Scanning Calorimetry (DSC), Fourier Transform Infrared Spectroscopy (FTIR), Field Emission Scanning Electron Microscopy (FE-SEM) and Energy-Dispersive X-ray Spectroscopy (EDXS). The dissolution profiles and bioactivity of the BGNs-coated PGLA biopolymers were assessed through Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). Tensile strength tests were conducted on the biopolymers before and after immersion in simulated body fluid to evaluate the impact of the BGNs coating on the degradation of PGLA biopolymers. Incorporating BGNs into PGLA resulted in improved tensile strength properties. The study also found that increasing the BGNs ions content facilitated the formation of a hydroxycarbonate apatite (HCA) layer in Dulbecco’s Modified Eagle Medium and medium with L-glutamine and sodium bicarbonate solutions. In vitro bioactivity tests demonstrated that the coated suture biopolymers exhibited enhanced attachment, migration, and proliferation of fibroblasts, indicating favorable biocompatibility of the biomaterial for clinical applications.

Transmission of Genetic Material and Malignant Cells of Cutaneous Origin via Surgical Sutures.

Seeding of skin cancer cells following diagnostic or therapeutic surgical procedures can occur and might cause local recurrences. As current preferred therapy for skin malignancy is surgical excision, seeding of tumour cells by manipulating malignant tissue or suturing can be another factor leading to recurrences. To evaluate whether genetic material and malignant cells adhere to standard suture materials. This prospective study included patients who underwent excision of skin lesions. Monofilament and braided sutures were examined. Sutures were passed through the observed tumour or healthy skin margins and were examined for DNA material and cells by cytological analysis, cell culture and characterization, and DNA analysis. Twenty-two patients and 148 sutures were included. DNA quantification showed DNA material on all sutures, with no significant difference between braided and monofilament sutures. Cytological analysis showed that all slides prepared from cell blocks contained normal squamous and atypical cells. Cell culture and characterization showed viable cells adhering to the sutures under direct light microscopy. Cell cultures showed rapid proliferation of epithelial cells from squamous cell carcinoma specimens. Suture materials carry DNA material and cells, including malignant cells of cutaneous origin and may seed them at distant sites.

Poly(hexamethylene biguanide) immobilized non-absorbable and antimicrobial PET fiber for surgical suture applications: synthesis, characterization and in vitro cytocompatibility assessment

Poly(hexamethylene biguanide) immobilized non-absorbable and antimicrobial PET fiber for surgical suture applications: synthesis, characterization and in vitro cytocompatibility assessment

High-Performance Dopamine-Based Supramolecular Bio-Adhesives.

The need for wound closure or surgical procedures has been commonly met by the application of sutures. Unfortunately, these are often invasive or subject to contamination. Alternative solutions are offered by surgical adhesives that can be applied and set without major disruption; a new class of supramolecular-based adhesives provides potential solutions to some of these challenges. In this study, a series of polymers utilizing dopamine as a self-assembling unit are synthesized. It is found that these motifs act as extremely effective adhesives, with control over the mechanical strength of the adhesion and materials' tensile properties enabled by changing monomer feed ratios and levels of cross-linking. These materials significantly outperform commercially available bio-adhesives, showing yield strengths after adhesion at least two times higher than that of BioGlue and Tisseel, as well as the ability to re-adhere with significant recovery of adhesion strength. Promisingly, the materials are shown to be non-cytotoxic, with cell viability > 90%, and able to perform in aqueous environments without significant loss in strength. Finally, the removal of the materials, is possible using benign organic solvents such as ethanol. These properties all demonstrate the effectiveness of the materials as potential bio-adhesives, with potential advantages for use in surgery.

The Model Study of Phase-Transitional Magnetic-Driven Micromotors for Sealing Gastric Perforation via Mg-Based Micropower Traction.

Gastric perforation refers to the complete rupture of the gastric wall, leading to the extravasation of gastric contents into the thoracic cavity or peritoneum. Without timely intervention, the expulsion of gastric contents may culminate in profound discomfort, exacerbating the inflammatory process and potentially triggering perilous sepsis. In clinical practice, surgical suturing or endoscopic closure procedures are commonly employed. Magnetic-driven microswarms have also been employed for sealing gastrointestinal perforation. However, surgical intervention entails significant risk of bleeding, while endoscopic closure poses risks of inadequate closure and the need for subsequent removal of closure clips. Moreover, the efficacy of microswarms is limited as they merely adhere to the perforated area, and their sealing effect diminishes upon removal of the magnetic field. Herein, we present a Fe&Mg@Lard-Paraffin micromotor (LPM) constructed from a mixture of lard and paraffin coated with magnesium (Mg) microspheres and iron (Fe) nanospheres for sutureless sealing gastric perforations. Under the control of a rotating magnetic field, this micromotor demonstrates precise control over its movement on gastric mucosal folds and accurately targets the gastric perforation area. The phase transition induced by the high-frequency magnetothermal effect causes the micromotor composed of a mixed oil phase of lard and paraffin to change from a solid to a liquid phase. The coated Mg microspheres are subsequently exposed to the acidic gastric acid environment to produce a magnesium protonation reaction, which in turn generates hydrogen (H2) bubble recoil. Through a Mg-based micropower traction, part of the oil phase could be pushed into the gastric perforation, and it would then solidify to seal the gastric perforation area. Experimental results show that this can achieve long-term (>2 h) gastric perforation sealing. This innovative approach holds potential for improving outcomes in gastric perforation management.

IMPLANTABLE MEDICAL DEVICES: A NON INVASIVE AND COSMETIC FRONTIER FOR WOUND CLOSURE

Abstract Cardiovascular implantable electronic devices (CIEDs) implantation procedures have undergone continuous improvement. Every aspect of the procedure can contribute to these improvements, including incision closure. The aim of this study was to assess the accuracy and validity of a non–invasive method using adhesive skin closure strips for wound closure of CIEDs in older adults, instead of surgical suture, evaluating parameters such as infection, erythema, skin reaction, itching, pain, oedema, time for closure, cosmetic outcomes and patients’ satisfaction. A retrospective study was carried out in 152 subjects (mean age 81 +9.3 years).undergoing application of adhesive strips after CIEDs substitution/implant and 132 usual care control subjects (mean age 76.6+8.9). Variables considered were: age, gender, risk factors for wound complications. Wound evaluation was conducted by using the Visual Analogue Scale (VAS) and the Patient and Observer Scar Assessment Scale (POSAS). Operative time for closing the incision and for removing sutures or strips were significantly lower in both application and removal in the adhesive strip group. At follow–up evaluations, each parameter considered by evaluation of the patients and staff was significantly better than in the control group. Fewer complications were observed in the patients undergoing wound closure wit adhesive strips. Previoulsy, to the best of our knowledge, the use of adhesive strips in closing surgical wounds of patients undergoing CIEDs implant/replacement has never been considered. Adhesive strips for wound closure of CIEDs incision are characterized by shorter procedural time, optimal early and late cosmetic results, fewer complications in older patients and is cheaper. Its use for CIEDs wound closure is reasonably supported.

A Novel Coated Suture Displays Antimicrobial Activity Without Compromising Structural Properties

BackgroundTreated or coated sutures promise to prevent contamination of wounds. PurposePurpose of the study was to coat surgical sutures with a new quaternary ammonium silane (QAS) antimicrobial compound at two different application temperatures and then to evaluate resulting structural, physical, mechanical, and biological properties. Study Design, Setting and SampleIn-vitro and in-vivo studies were conducted using male albino Wistar rats approved by Joint Ethical Committee of IMU and Postgraduate Medical Institute, Lahore. Only suture samples, coated uniformly with verified presence of the compound and of adequate length were used. Samples which were not coated uniformly and with inadequate length or damaged were excluded. Predictor VariablesPredictor variables were sutures with and without QAS coatings and different temperatures. Sutures were coated with QAS at 0.5% and 1.0% wt/vol using dip coating technique and sutures with and without QAS coating were tested at 25oC and 40oC temperatures. Main Outcome VariableOutcome variables of structural and physico-mechanical, properties of QAS coated and non-coated sutures were measured using Fourier transform infrared spectroscopy (FTIR) (for structural changes), confocal laser and scanning electron (for diameter changes), and tensile strength/modulus (for mechanical testing). Biologic outcome variables were tested (bacterial viability); macrophage cultures from Wistar rats were tested (M1/M2 polarization detecting IL-6 and IL-10). Macrophage cells were analyzed with CD80+ (M1) and CD163+ (M2). Chemotaxis Index was calculated as a ratio of quantitative fluorescence of cells. CovariatesNot applicable. AnalysisOrdinal data among groups were compared using Wilcoxon Mann-Whitney U test along with comparison of histological analysis using Wilcoxon Sign-rank test (p < 0.05). ResultsFTIR peak at 1490 cm-1 confirmed presence of QAS on suture’s surfaces with significant increase (p<0.05) in diameter (0.99±0.5-mm) and weight (0.77±0.02-mg) observed for 1% QAS-groups treated at 40°C. Non-coated samples heated at 25°C had significantly (p<0.05) less diameters (0.22±0.03-mm) and weights (0.26±0.06-mg). Highest tensile strength/modulus was observed for 0.5% QAS-coated samples which also had significantly high antibacterial characteristics than other sutures (p<0.05). QAS-coated sutures significantly increased M1 and M2 markers. Conclusions and RelevanceQAS coating conferred antibacterial action properties without compromising physical and mechanical properties of the suture.

An Analysis of Surgical Factors Associated With Clinically Significant Eyelid Edema (CSEE) in Patients Undergoing Blepharoplasty: Lid Crease Techniques Associated with CSEE.

Severe postoperative edema after eyelid surgery can have negative clinical and psychological effects. In this study, the authors investigated whether surgical factors, including surgical techniques and suture type, were associated with clinically significant eyelid edema (CSEE). A chart review was performed on 269 patients who underwent upper eyelid blepharoplasty with or without external levator advancement by 2 surgeons at a single institution between January 2021 and December 2022. Postoperative photos were graded by 2 physicians for eyelid edema using a standardized grading scale ranging from 0 (no edema) to 3 (severe edema). CSEE was defined either as having a grade of 3 at any point postoperatively or any grade that was 1 or greater after 90 days postoperatively. Logistic regression controlling for race was used for analysis; the statistical significance level was defined as p < 0.05. Of 269 patients, 56 developed CSEE. Of those who underwent blepharoplasty with mini crease enhancement (closure with every other bite incorporating levator aponeurosis), 40.5% developed CSEE versus 12.5% of those without ( p < 0.001). Patients with lid crease formation using buried interrupted sutures had greater CSEE than those with externalized interrupted sutures removed at 1 week (43.8% versus 11.5%, p < 0.01). There was no increased risk of CSEE with additional procedures performed versus blepharoplasty alone. Patients who underwent blepharoplasty with mini crease enhancement, where more than 4 sutures are placed from skin to levator, and/or had buried suture lid crease formation had greater rates of CSEE.

Evaluating and Comparing the Tensile Strength and Clinical Behavior of Monofilament Polyamide and Multifilament Silk Sutures: A Systematic Review

Objective: This systematic review was carried out with the primary objective of verifying which suture (polyamide or silk) of two non-resorbable suture materials with different structures had better/greater tensile strength/resistance to tension, thereby presenting better mechanical behavior. The secondary objective was to verify which one had better performance. The null hypothesis was that both types of sutures had the same behavior. Methods: This systematic study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The focused clinical question was: “In patients that underwent oral surgery treatment (P), is there significantly higher tensile strength/resistance for silk sutures (I) or for polyamide sutures (C) when comparing the outcomes (O)?”. The bibliographic search was conducted on ScienceDirect, B-On, and PubMed/MedLine between March and May 2023. The following MeSH terms were defined: sutures, breaking strength, tensile strength, oral surgery, and dentistry, which were articulated and combined using Boolean operators. There were restrictions, such as articles published in Portuguese, Spanish, or English between 1 January 2018 and 3 April 2023. The quality assessment involved the use of the Joanna Briggs Institute (JBI) checklist for RCTs and the QUIN tool (Quality Assessment Tool For In Vitro Studies) for in vitro assays. Results: Ten articles were included in this review (eight in vitro studies and two RCTs). For the RCTs, there were moderate and high levels of bias, whereas in the in vitro studies, three were classified as having a high risk of bias and five as moderate risk. The results proved that suture thread with a monofilament polyamide physical structure causes a less inflammatory reaction owing to less bacterial retention and capillarity, while multifilament sutures, such as silk, have superior mechanical characteristics. Regarding hydration, the evidence demonstrated that the preservation and stability of mechanical properties lacked uniformity. Otherwise, hyaluronic acid (HA) presents a promising solution with the same characteristics and antibacterial capabilities. Conclusion: It was possible to reject the null hypothesis that both types of sutures had the same behavior and result. It was proven by the results above that sutures with a monofilament polyamide physical structure cause a less inflammatory reaction owing to less bacterial retention and capillarity. In contrast, multifilament sutures (silk) have superior mechanical characteristics. Regarding hydration using chlorohexidine in surgical sites, the evidence demonstrated in the preservation and stability of mechanical properties lacks uniformity and congruence. However, HA seems to present a promising option with the same characteristics and antibacterial capabilities.

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.

Bi-layered hydrogel conduit integrating microneedles for enhanced neural recording and stimulation therapy in peripheral nerve injury repair

Nerve conduit is an alternative strategy in peripheral nerve injuries (PNI) treatment both for neural signals recording and therapeutic electrical stimulation (ES). Most conventional conduits suffer from surgical suturing and lacking real-time insights of nerve recovery, as well as failing in integrating therapy strategies. Herein, we introduce a bi-layered hydrogel conduit with microneedles (BHCM), in which poly (N-isopropylacrylamide) (PNIPAm)-incorporated polyethyleneimine (PEI) forms the outer layer for conductivity and electro-driven drug loading and release, whereas PNIPAm/alginate/tannic acid hydrogel (PNIPAm/SA/TA) forms the inner layer to ensure biocompatible mechanics and strong tissue adhesion. Meanwhile, the differences in doping manipulated different critical solution temperature (LCST) and swelling between the double layers determine the self-curling performance. Therefore, the BHCM responds to temperature and self-curls into conduit to wrap and bind to sciatic nerve, avoiding the complicated suturing and enhancing the interfacial electrical transmission. By puncturing the epineurium, the microneedles strongly enhance the electrochemical performance, and synergistically facilitate controllable drug delivery as well as electrical stimulation and recording efficiency. Further, BHCM is demonstrated to regulate macrophage polarization from M1 to M2 through electrically stimulated Rhein release, thereby reducing inflammation and facilitating diabetic PNI repair. The present design aims to improve biosafety, surgical simplicity to realize overall recovery of injured nerves, making it a promising candidate for advanced peripheral nerve repair strategies.

A surgical approach to the rabbit patient: part 1

Rabbit surgery, as well as owner expectations, are constantly evolving and increasing. It is essential that the unique anatomical and physiological differences between rabbits and more frequently seen mammalian patients are fully understood before undertaking any surgery. All patients should undergo a full clinical examination and be stabilised before surgery where possible. All essential equipment should be ready at hand. It is important to optimise patient and surgeon positioning, as well as to use appropriately sized suture material, haemostasis, magnification and lighting to improve surgical technique, regardless of the procedure or organ system being operated on. This first of two articles discussing rabbit surgery takes the reader through pre-operative essentials for rabbits, as well as skin, nasal, oral, ophthalmological and aural surgery in rabbits.

New dynamic suture material for tendon transfer surgeries in the upper extremity – a biomechanical comparative analysis

BackgroundEarly mobilization after tendon surgery is crucial to avoid commonly observed postoperative soft tissue adhesions. Recently, a new suture was introduced (DYNACORD; DC) with a salt-infused silicone core designed to minimize laxity and preserve consistent tissue approximation in order to avoid gap formation and allow early mobilization.AimsTo compare the biomechanical competence of DC against a conventional high strength suture (FiberWire; FW) in a human cadaveric tendon transfer model with an early rehabilitation protocol.MethodsSixteen tendon transfers (flexor digitorum superficialis (FDS) IV to flexor pollicis longus (FPL)) were performed in 8 pairs human cadaveric forearms using either DC or FW. Markings were set 0.8 cm proximally and 0.7 cm distally to the level of the interweaving zone of the transfer. All specimens underwent repetitive thumb flexion against resistance in 9 intermittent series of 300 cycles each, simulating an aggressive postoperative rehabilitation protocol. After each series, the distance of the proximal marker to the interweaving zone (proximal), the length of the interweaving zone (intermediate) and the distance of the distal marker to the interweaving zone (distal) were measured.ResultsPooled data over all nine series, normalized to the immediate postoperative status, demonstrated no significant differences between FW and DC (p ≥ 0.355) for the proximal and distal markers. However, at the intermediate zone, DC was associated with significant length shortening (p < 0.001) compared to FW without significant length changes (p = 0.351). Load to catastrophic failure demonstrated significant higher forces in FW (p = 0.011). Nevertheless, due to failure mainly proximal or distal of the transfer zone, these loads are not informative.ConclusionFrom a biomechanical perspective, DC preserved tissue approximation and might be considered as a valid alternative to conventional high-strength sutures in tendon transfer surgery. DC might allow for a shorter interweaving zone and a more aggressive early postoperative rehabilitation program, possibly avoiding commonly observed postoperative soft tissue adhesions and stiffness.

In Vitro Study of Tensile Strength Comparison of Selected Nonabsorbable and Absorbable Suture Materials after Immersion in 0.12% Chlorhexidine Gluconate.

To compare the tensile strength (TS) of absorbable and nonabsorbable suture materials after immersion in 0.12% chlorhexidine gluconate. Six 4-0-gauge suture materials were used, namely silk (S), polypropylene (PP), polyamide 6 (PA6), polyglactin 910 (PG910), poliglecaprone 25 (PL25), and polydioxanone (PDX). A total of 540 suture materials were divided equally (90) into six groups and tested. These materials were divided into a nonimmersed condition (10) and two thermostatically controlled immersion media (40 each), using artificial saliva for the control group (CG) and 0.12% chlorhexidine gluconate for the test group (TG). The specimens were tied to prefabricated rubber rods before immersion and removed at the testing timepoint. By using a universal testing machine (Instron 5566) with hooks attached, a hook-mounted specimen TS testing was performed on days 0, 1, 3, 7, and 14 at a 10 mm/min crosshead speed until the material was stretched to failure, and the maximum TS was recorded in Newtons (N). The continuous variables were taken as the mean and standard deviation across the six study groups to assess the significance at α = 0.05. A two-factor analysis of variance (ANOVA) was performed to assess the TSs over time in different media. A Bonferroni correction was performed when the data were statistically significant according to a two-factor ANOVA. Intragroup statistical comparisons were performed by repeated ANOVA for each study group. All data were analyzed using SPSS 26. The suture material TS analysis showed that nonabsorbable suture materials maintained their TS throughout the study; silk exhibited different behaviors, decreasing in TS from baseline to day 1 and maintaining its TS until day 14. All absorbable suture materials decreased in TSs by day 14. The silk and PG910 samples in the TG performed significantly better than those in the CG. Prescribing 0.12% chlorhexidine gluconate as a postsurgical mouth rinse is safest when silk and PG910 are the optimal suture materials.

Thymol, a Monoterpenoid within Polymeric Iodophor Formulations and Their Antimicrobial Activities.

Antimicrobial resistance (AMR) poses an emanating threat to humanity's future. The effectiveness of commonly used antibiotics against microbial infections is declining at an alarming rate. As a result, morbidity and mortality rates are soaring, particularly among immunocompromised populations. Exploring alternative solutions, such as medicinal plants and iodine, shows promise in combating resistant pathogens. Such antimicrobials could effectively inhibit microbial proliferation through synergistic combinations. In our study, we prepared a formulation consisting of Aloe barbadensis Miller (AV), Thymol, iodine (I2), and polyvinylpyrrolidone (PVP). Various analytical methods including SEM/EDS, UV-vis, Raman, FTIR, and XRD were carried out to verify the purity, composition, and morphology of AV-PVP-Thymol-I2. We evaluated the inhibitory effects of this formulation against 10 selected reference strains using impregnated sterile discs, surgical sutures, gauze bandages, surgical face masks, and KN95 masks. The antimicrobial properties of AV-PVP-Thymol-I2 were assessed through disc diffusion methods against 10 reference strains in comparison with two common antibiotics. The 25-month-old formulation exhibited slightly lower inhibitory zones, indicating changes in the sustained-iodine-release reservoir. Our findings confirm AV-PVP-Thymol-I2 as a potent antifungal and antibacterial agent against the reference strains, demonstrating particularly strong inhibitory action on surgical sutures, cotton bandages, and face masks. These results enable the potential use of the formulation AV-PVP-Thymol-I2 as a promising antimicrobial agent against wound infections and as a spray-on contact-killing agent.