Suture Coatings Research Articles

Multifunctional Suture Coating for Combating Surgical Site Infections and Mitigating Associated Complications.

Despite advancements in preventive measures and hospital protocols, surgical site infections (SSIs) remain a significant concern following surgeries. Sutures, commonly used for wound closure, can serve as a platform for microbial adherence and contamination, leading to extensive debridement and recurrent antibiotic therapy. The emergence of drug resistance and the formation of biofilms on sutures have further complicated the management of SSIs. Drug-eluting sutures incorporating biocides like triclosan have limitations due to uncontrolled release and associated toxicity. Therefore, there is a need for alternative approaches to impart antimicrobial properties to sutures. In this study, we present a one-step covalent cross-linking method to coat surgical sutures with an antimicrobial small molecule, quaternary benzophenone-based antimicrobial (QSM). Additionally, the sutures are dip-coated with ibuprofen, a nonsteroidal anti-inflammatory drug with analgesic properties. The coated sutures maintained their morphological and tensile properties after in vivo implantation. The antimicrobial coating demonstrated efficacy against a broad-spectrum pathogens, including drug-resistant bacteria and fungi. The optimized formulation retained its biodegradability in vivo. Furthermore, the coated sutures exhibited ∼3 log reduction in methicillin-resistant Staphylococcus aureus (MRSA) burden in a subcutaneous implantation mouse model. Overall, this multifunctional coating provides antimicrobial properties to surgical sutures while preserving their mechanical integrity and biodegradability. These coated sutures have the potential to address the challenge of SSIs and contribute to improved surgical outcomes.

Controllable Drug Release Behavior of Polylactic Acid (PLA) Surgical Suture Coating with Ciprofloxacin (CPFX)-Polycaprolactone (PCL)/Polyglycolide (PGA).

Polylactic acid (PLA) surgical suture can be absorbed by human body. In order to avoid surgical site infections (SSIs), the drug is usually loaded on the PLA suture, and then the drug can release directly to the wound. Because the different types of wounds heal at different times, it is needed to control the drug release rate of PLA suture to consistent to the wound healing time. Two biopolymers, polyglycolide (PGA) and polycaprolactone (PCL), were selected as the carrier of ciprofloxacin (CPFX) drug, and then the CPFX-PCL/PGA was coated on the PLA suture. The degradation rate of drug-carrier can be controlled by adjusting the proportion of PCL/PGA, which can regulate the rate of CPFX drug release from PLA suture. The results show that the surface of PLA suture, coating with PCL/PGA, was very rough, which led to increased stitching resistance when we were suturing the wound. These materials, such as the PLA suture, the PCL/PGA carriers and the CPFX drug, were just physically mixed rather than chemically reacted, which was very useful for ensuring the original efficacy of CPFX drug. With the increasing of PCL in the carriers, both the breaking strength and elongation of these un-degraded sutures increased. During degradation, the breaking strength of all sutures gradually decreased, and the more PCL in the coating materials, the longer effective strength-time for the suture. With the increasing of PCL in the drug-carrier, the rate of drug releasing became lower. The drug release mechanism of CPFX-PCL/PGA was a synergistic effect of drug diffusion and PCL/PGA carrier dissolution.

Degradation and Drug-release Behavior of Polylactic Acid (PLA) Medical Suture Coating with Tea Polyphenol (TP) - Polycaprolactone (PCL)/Polyglycolide (PGA)

The drug-release time of suture should meet with the healing time of wound, so it is needed to control the drugrelease performance of polylactic acid (PLA) suture. In this paper, two biodegradable polymers with different degradation rates, such as polycaprolactone (PCL) and polyglycolide (PGA), were applied to carry the drug of tea polyphenol (TP). The drug-loading finishing solution which is made of PCL/PGA carriers and TP, was coated on the PLA suture. The drug-release rate and time of PLA suture could be regulated by adjusting the proportion of PCL/PGA carriers. The results indicate that the surface of drug-loaded PLA suture becomes rough. There is no obvious chemical reaction among the drug, carriers and PLA suture, just physical adhesion. With the increasing of PCL in drug-carriers, the strength of suture gradually increases. At 70/30 of PCL/PGA, the fracture elongation of suture reaches the highest point. In process of degradation, the surface of drugloaded PLA suture appears some holes after 25 weeks. The strength of sutures decreases gradually during degradation, and the effective strength time of sutures with various proportions of PCL/PGA is different. The drug-release rate of the suture is fast at early stage and slow at later stage and the higher the PGA proportion is, the faster the drug-release rate of the suture is.

Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI).

BackgroundSurgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications.ObjectivesThis study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure.MethodsAs a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups.ResultsZone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on coated sutures with higher roughness for palmitate coatings and sustaining integrity of coated sutures. Adherent S. aureus were found via SEM on all types of investigated sutures. The novel antimicrobial sutures showed significantly less viable adhered S. aureus bacteria (up to 6.1 log) compared to Vicryl® Plus (0.5 log). Within 11 μg/cm drug-containing sutures, octenidine-palmitate (OL11) showed the highest number of viable adhered S. aureus (0.5 log), similar to Vicryl® Plus. Chlorhexidine-laurate (CL11) showed the lowest number of S. aureus on sutures (1.7 log), a 1.2 log greater reduction. In addition, planktonic S. aureus in suspensions were highly inhibited by CL11 (0.9 log) represents a 0.6 log greater reduction compared to Vicryl® Plus (0.3 log).ConclusionsNovel antimicrobial sutures can potentially limit surgical site infections caused by multiple pathogenic bacterial species. Therefore, a potential inhibition of multispecies biofilm formation is assumed. In detail tested with S. aureus, the chlorhexidine-laurate coating (CL11) best meets the medical requirements for a fast bacterial eradication. This suture coating shows the lowest survival rate of adhering as well as planktonic bacteria, a high drug release during the first–clinically most relevant– 48 hours, as well as biocompatibility. Thus, CL11 coatings should be recommended for prophylactic antimicrobial sutures as an optimal surgical supplement to reduce wound infections. However, animal and clinical investigations are important to prove safety and efficacy for future applications.

Nanofibrillar cellulose-alginate hydrogel coated surgical sutures as cell-carrier systems.

Hydrogel nanomaterials, especially those that are of non-human and non-animal origins, have great potential in biomedical and pharmaceutical sciences due to their versatility and inherent soft-tissue like properties. With the ability to simulate native tissue function, hydrogels are potentially well suited for cellular therapy applications. In this study, we have fabricated nanofibrillar cellulose-alginate (NFCA) suture coatings as biomedical devices to help overcome some of the limitations related to cellular therapy, such as low cell survivability and distribution out of target tissue. The addition of sodium alginate 8% (w/v) increased the NFCA hydrogel viscosity, storage and loss moduli by slightly under one order of magnitude, thus contributing significantly to coating strength. Confocal microscopy showed nearly 100% cell viability throughout the 2-week incubation period within and on the surface of the coating. Additionally, typical morphologies in the dual cell culture of spheroid forming HepG2 and monolayer type SK-HEP-1 were observed. Twelve out of 14 NFCA coated surgical sutures remained intact during the suturing operation with various mice and rat tissue; however, partial peeling off was observed in 2 of the coated sutures. We conclude that NFCA suture coatings could perform as cell-carrier systems for cellular based therapy and post-surgical treatment.

New Biofunctional Loading of Natural Antimicrobial Agent in Biodegradable Polymeric Films for Biomedical Applications.

The study focuses on the development of novel Aloe vera based polymeric composite films and antimicrobial suture coatings. Polyvinyl alcohol (PVA), a synthetic biocompatible and biodegradable polymer, was combined with Aloe vera, a natural herb used for soothing burning effects and cosmetic purposes. The properties of these two materials were combined together to get additional benefits such as wound healing and prevention of surgical site infections. PVA and Aloe vera were mixed in a fixed quantity to produce polymer based films. The films were screened for antibacterial and antifungal activity against bacterial (E. coli, P. aeruginosa) and fungal strains (Aspergillus flavus and Aspergillus tubingensis) screened. Aloe vera based PVA films showed antimicrobial activity against all the strains; the lowest Aloe vera concentration (5%) showed the highest activity against all the strains. In vitro degradation and release profile of these films was also evaluated. The coating for sutures was prepared, in vitro antibacterial tests of these coated sutures were carried out, and later on in vivo studies of these coated sutures were also performed. The results showed that sutures coated with Aloe vera/PVA coating solution have antibacterial effects and thus have the potential to be used in the prevention of surgical site infections and Aloe vera/PVA based films have the potential to be used for wound healing purposes.

The Effect of 1-Ethyl-3-(3-Dimethylaminopropyl) Carbodiimide Suture Coating on Tendon Repair Strength and Cell Viability in a Canine Model

To determine if impregnating a suture with a cross-linking agent, 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC), improved suture pull-out strength and cell viability. Canine flexor digitorum profundus tendons were cut in canine zone D, and a single suture loop was placed in each end, with sutures soaked in either saline or an EDC solution with a concentration of 1%, 10%, or 50%. Suture pull-out strength, stiffness, and elongation to failure was determined by pulling the loop until failure. Cytotoxicity of the EDC treatment was evaluated by suspending treated sutures over cultured tenocytes. Mechanical properties for the EDC-treated side were improved over controls when treated with the 10% and 50% EDC solutions. The ratio of dead to live cells was significantly increased at all distances from the suture for the 50% EDC-treated group. Suture treated with a 10% EDC solution provided the best combination of mechanical reinforcement and limited toxicity. Sutures so treated may improve the ability of a tendon repair to sustain early mobilization.

New Bactericidal Surgical Suture Coating

This paper demonstrates the effectiveness of a new antimicrobial suture coating. An amphiphilic polymer, poly[(aminoethyl methacrylate)-co-(butyl methacrylate)] (PAMBM), inspired by antimicrobial peptides, was bactericidal against S. aureus in time-kill experiments. PAMBM was then evaluated in a variety of polymer blends using the Japanese Industrial Standard (JIS) method and showed excellent antimicrobial activity at a low concentration (0.5 wt %). Using a similar antimicrobial coating formula to commercial Vicryl Plus sutures, disk samples of the coating material containing PAMBM effectively killed bacteria (98% reduction at 0.75 wt %). Triclosan, the active ingredient in Vicryl Plus coatings, did not kill the bacteria. Further Kirby-Bauer assays of these disk samples showed an increasing zone of inhibition with increasing concentration of PAMBM. Finally, the PAMBM-containing coating was applied to sutures, and the morphology of the coating surface was characterized by SEM, along with Vicryl and uncoated sutures. The PAMBM-containing sutures killed bacteria more effectively (3 log(10) reduction at 2.4 wt %) than Vicryl Plus sutures (0.5 log(10) reduction).

Controllable protein delivery from coated surgical sutures

In contemporary tissue engineering there is a need for drug delivery approaches that offer controllable release kinetics from common surgical devices, particularly at healing tissue interfaces. We describe a generally applicable approach to release therapeutic proteins from sutures in a controllable manner. Results demonstrated that several common, commercially available surgical sutures could be coated with nano-porous hydroxyapatite mineral layers using a biomimetic process. The nanoscale morphology, composition, and dissolution rate of these coatings were controlled by varying the degree of carbonate substitution during calcium phosphate (CaP) mineral growth. Coated sutures could efficiently bind both an acidic protein and a basic protein, and subsequent sustained protein release was controllable by varying the coating composition. Interestingly, decreases in pH could trigger enhanced coating dissolution and, in turn, increased protein release kinetics. Importantly, CaP coatings on Orthocord sutures were robust enough to endure under clinically relevant conditions, as protein-containing coatings remained intact after multiple passages through sheep tendon and meniscus tissues. The use of CaP-coated Orthocord sutures in a sheep rotator cuff repair model demonstrated that suture coatings did not negatively impact their utility at a bone–tendon interface. Considering the ubiquitous use of sutures and their proximity to damaged tissue, the approach described in this study may provide an efficient, site-specific way of regulating new tissue formation in emerging tissue engineering schemes.

New Anti-infective Coatings of Surgical Sutures Based on a Combination of Antiseptics and Fatty Acids

Wound infection is a complication feared in surgery. The aim of this study was to develop new anti-infective coatings of surgical sutures and to compare the anti-microbial effectiveness and biocompatibility to the well-established Vicryl Plus®. Synthetic absorbable PGA surgical sutures were coated with three different chlorhexidine concentrations and two different octenidine concentrations in combination with palmitic acid and lauric acid. Drug-release kinetics lasting 96 h were studied in phosphate-buffered saline at 37°C. Anti-infective characteristics were determined by measuring the change in optical density of Staphylococcus aureus suspensions charged with coated sutures over time. Microorganisms adsorbed at the surface of coated sutures were assessed on blood agar plates and coated sutures eluted for 24 h were placed on bacterial lawns cultured on Mueller–Hinton plates to prove retained anti-microbial potency. A cell proliferation assay was performed to assess the degree of cytotoxicity. Anti-infective characteristics and biocompatibility were compared to Vicryl Plus®. A coating technology for slow-release drug-delivery systems on surgical sutures could be developed. All coatings showed a continuous drug release within 96 h. Individual chlorhexidine and octenidine coated sutures showed superior anti-infective characteristics but inferior biocompatibility in comparison to Vicryl Plus®. We conclude that the developed anti-infective suture coatings consisting of lipid-based drug-delivery systems in combination with antiseptics are highly effective against bacterial colonization in vitro; however, drug doses have to be adjusted to improve biocompatibility.

The polyoxaesters

AbstractThis paper provides a review of a new class of synthetic absorbable polyesters, the ‘polyoxaesters’. We describe what they are and provide routes of preparation to the homopolymers, as well as their copolymers with lactones. Structure–property relationships are outlined and applications with commercial potential are discussed. Finally, two potential surgical applications, suture coatings and adhesion prevention barriers, are presented in more detail. Copyright © 2007 Society of Chemical Industry

The Effect of Adjustable Suture Techniques on Scleral Resistance

The effect of adjustable suture strabismus surgery techniques on the ease of the postoperative adjustment has not been determined. An in vitro animal model was developed to compare several intraoperative variables with the ability to adjust the sutures. The amount of force required to advance and recess the suture was measured using different sutures, suture coatings, needles, and scleral tunnel techniques. Scleral tunnels placed at an angle to the muscle insertion caused significantly greater scleral resistance as compared with tunnels placed perpendicular to the insertion. Although differences were noted in the scleral resistance with different needles, suture coatings, and suture materials, there was a considerable overlap of the effect. Scleral tunnels placed perpendicular to the muscle insertion and parallel to the plane of action of the muscle offer the best technique for minimizing scleral resistance. Other less important factors include shorter scleral tunnels, larger needles, and special suture coatings.

Radiographic evidence of absorption of hydron from an obturated root canal

Hydron (poly-2-hydroxyethyl methacrylate) was introduced to medicine in 1960 (1) and since then it has been used clinically in breast reconstructive surgery (2, 3), suture coatings (4), and soft contact lenses (5). Hydron was introduced to clinical dentistry in the mid1970's by Goldman et al. (6, 7), Rising et al. (8), and Benkel et al. (9). It has been reported to be an ideal root canal filling material for the following reasons: (a) it is easy to use because it is an injectable material; (b) it is nonirritating; (c) it obturates the root canal system well; and (d) it does not support bacterial growth (710). However, recent reports have cast doubt on the ideal nature of Hydron as a root canal filling material. Langeland et al. (11) and Tanzilli et al. (12, 13), using animal models, have shown that Hydron has a high degree of absorbability. Hydron also elicited a significantly greater degree of leakage when compared with