Synthetic Absorbable Suture Research Articles

Comparison of E. coli Infiltration between New Synthetic Absorbable Sutures

Purpose: The proper selection of suture is very important to minimize infection after gastrointestinal anastomosis and closure, which is one of the causes of postoperative complications such as leakage and stricture, etc, in the surgical field. Thus this study focuses on which suture can reduce bacterial infection after surgical operation by comparing in vitro microbial infiltration rates of three synthetic absorbable sutures and that of silk - a relatively absorbable material, using E. coli. Methods: Four different, sterilized kinds of absorbable sutures were used for two experiments. In experiment 1, the cut-off suture was directly applied to the standard method agar plate and cultured for observation. In experiment 2, the cut-off suture was diluted with 1 ml of tryptic soy broth to be smeared and cultured in the standard method agar plate and counted using a spectrophotometer. Results: The first experiment revealed that bacterial growth was not observed in the monofilament and antibiotic-coated multifilament sutures, while the other sutures of multifilament structure were invaded by bacteria. In the second experiment, counting and averaging the colony from five plates of each test showed that the number of E. coli of monofilament suture, antibiotics-coated polyglactin, polyglactin and silk were 0±0, 39.3±14.4, 208.6±76.6, 59.4±26.7, respectively. Conclusion: Sutures of monofilament structure are believed to be a relatively safe material that can be used for gastrointestinal anastomosis and closure since it has lower bacterial infiltration rates than sutures of multifilament structure.

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.

Editor’s Choice

Editor’s Choice

Evidence‐based intrapartum care in Cali, Colombia: a quantitative and qualitative study

To measure the rate of use of selected intrapartum obstetric practices and to explore the factors associated with their use. Prospective quantitative and qualitative study. Fifteen public and private hospitals in Cali, Colombia. Quantitative arm: 1,767 low-risk women delivering a single live baby; qualitative arm: 36 intrapartum care providers. Quantitative analysis of women's clinical charts for measuring the rates of obstetric practices. Qualitative analysis of audiotaped semi-structured interviews with intrapartum care providers. Rates of use of ten intrapartum obstetric practices and associated factors and intrapartum care providers' views on evidence-based obstetric practice. Rates for the ineffective practices of enema use, perineal/pubic shaving, and routine intravenous infusion during labour were around 75%. Episiotomy rates for primiparae and multiparae were 70 and 22%, respectively. Rates for the beneficial practices of active management of the third stage of labour and allowing women's choice of position during the first stage of labour were around 45%. Companionship during labour, external cephalic version for breech presentation at term, and absorbable synthetic sutures for episiotomy showed rates of utilisation lower than 15%. Hospital characteristics, type of intrapartum care provider, and women's medical insurance status were associated with use of selected practices. Barriers and opportunities for implementing evidence-based practices in routine obstetric care were identified. Intrapartum care in Cali, Colombia, is not guided by the best available evidence. Effective change strategies should be undertaken to encourage the adoption of obstetric practices clearly demonstrated as effective and to discard those that are ineffective.

Intracorporeal Suture Closure of the Internal Inguinal and Vaginal Rings in Foals and Horses

To report a technique for repair or prevention of inguinal hernia in horses using intracorporeal suture closure of the internal inguinal and vaginal rings. Case series. Foals (n=6) and geldings (n=2). After selection of a peri-umbilical telescope portal, instrument portals were made unilaterally or bilaterally, as needed. Herniated viscera was reduced, castration (foals) or spermatic cord remnant transection at the internal inguinal ring (adults) performed, and then simple interrupted intracorporeal sutures of synthetic absorbable suture material were used to close the internal inguinal and vaginal rings. There was no recurrence of inguinal hernia. Postoperative morbidity was minimal and cosmetic outcome was comparable to that achieved with conventional, open techniques. Laparoscopic, primary closure of the internal inguinal ring by use of intracorporeal sutures provides a secure barrier to herniation and costs considerably less than using endoscopic staples. Laparoscopic suture closure of the internal inguinal and vaginal rings provides safe and effective repair of inguinal hernia in horses.

Usefulness of Absorbable Sutures in Preventing Surgical Site Infection in Hepatectomy

We evaluated the usefulness of synthetic absorbable sutures (Vicryl) in preventing surgical site infection (SSI) after hepatectomy. A rat model of 60% partial hepatectomy was used. Bleeding from the cut surface of the liver was controlled by using two suture types: silk and Vicryl. In the Vicryl group, the lesser omentum was slightly adherent to the cut surface of the liver, while in the silk group, the suture remained, and severe adhesions were found. The number of Staphylococcus aureus was significantly larger in the silk group. We compared a group of patients (n = 125) who underwent hepatectomy using silk with one (n = 188) using Vicryl. The respective incidences of SSI and infection on the cut surface of the liver in the Vicryl group (3.2, 1.6%) were significantly lower than in the silk group (11.2, 8.8%). In accordance with the results of multivariate analysis, duration of operation, use of silk sutures and the complication of bile leakage were selected as independent factors. The risk of SSI in the silk group was 3.4 times that in the Vicryl group. The use of synthetic absorbable sutures, instead of silk sutures, in all the procedures of hepatectomy contributed significantly to the prevention of SSI.

Breaking strength and elasticity of synthetic absorbable suture materials incubated in phosphate-buffered saline solution, milk, and milk contaminated withStreptococcus agalactiae

Breaking strength and elasticity of synthetic absorbable suture materials incubated in phosphate-buffered saline solution, milk, and milk contaminated with<i>Streptococcus agalactiae</i>

In vitro and in vivo degradation behaviors of synthetic absorbable bicomponent monofilament suture prepared with poly( p-dioxanone) and its copolymer

A synthetic absorbable bicomponent monofilament suture (MonoFlex), composed of poly( p-dioxanone) and its copolymer, was prepared by a conjugate spinning method, and its degradation behavior was investigated in vitro and in vivo. MonoFlex degraded by hydrolysis, and retained approximately 55% of its original strength after four weeks of incubation in PBS at 37 °C. About 70% of the original strength was maintained after four weeks of implantation in rats, and the suture material was completely absorbed after 180–210 days post-implantation in rats. No remarkable tissue reactions were observed during degradation, and foreign body reactions were similar to those of commercially available suture materials composed of poly( p-dioxanone). This study to monitor the degradation behavior of monofilament sutures in vitro as well as in vivo may be useful in the development of novel suture materials for extended wound support.

Breaking strength and elasticity of synthetic absorbable suture materials incubated in phosphate-buffered saline solution, milk, and milk contaminated with Streptococcus agalactiae

To determine in vitro effects of PBSS, milk, and bacteria-contaminated milk (BCM; contaminated by Streptococcus agalactiae) on properties of 3 synthetic absorbable suture materials. 3 types of synthetic absorbable suture materials (poliglecaprone 25, polyglycolic acid, and polydioxanone). Suture materials were tested to determine breaking strength and elasticity before (day 0) and after incubation in 3 media (PBSS, milk, and BCM) for 7, 14, and 21 days. A loop of suture material was elongated at a rate of 60 mm/min until it reached the breaking point. Tensile properties were statistically analyzed among media and incubation times. Incubation in milk and BCM significantly decreased breaking strength and elasticity of poliglecaprone 25, compared with results for incubation in PBSS. Incubation in BCM significantly decreased tensile properties of polyglycolic acid suture, compared with results for incubation in PBSS and milk. After incubation for 21 days, tensile properties of polydioxanone did not differ significantly among the media but were significantly decreased from values on day 0. On the basis of this study, poliglecaprone 25 is an inappropriate suture material for use in teat surgery. Polyglycolic acid suture should be avoided in teats of cattle with mastitis. Of the suture materials tested, polydioxanone was best suited for use in teat surgery, as determined on the basis of material testing after incubation in milk, even when the milk was contaminated with bacteria.

Synthetic Absorbable Sutures for Leading-edge Surgery

合成生体吸収性縫合糸が外科治療に果たす重要な役割と,そこで期待される物理寿命,物質寿命からの化学設計,高分子設計のコンセプトを述べた。また外科手術で縫合糸に要求される高い操作性が,先端的な製品の製糸技術でどのようにして開発されたかについても触れた。

Intraoperative finding of structural abnormality of bovine pericardial aortic prosthesis

reason for broken sutures. Broken sutures made of PDS cord may occur several weeks after surgery when patients have a persistent cough. PDS cord sutures do not have sufficient reliability to close the sternum, especially in patients with chronic obstructive pulmonary dysfunction and obesity. Reference 1. Ray JA, Doddi N, Regula D, Williams JA, Melverger, Polydioxane (PDS), a novel monofilament synthetic absorbable suture. Surgery, Gynecology & Obstetrics 1981;153:497-507.

Capillary Activity of Surgical Sutures and Suture- Dependent Bacterial Transport: A Qualitative Study

To evaluate the multitude of new synthetic absorbable sutures (both monofilament and multifilament) in comparison with older materials with regard to capillarity and bacterial transport. Sutures of United States Pharmacopoeia (USP) 4-0 thickness were arranged in a three-chamber system under sterile conditions. Either a colorant (liquid transport evaluation) or bacteria (bacterial transport evaluation) were added to the contamination chamber, and movement of colorant or bacteria was evaluated for as long as 30 days. None of the monofilament sutures transported colorant or bacteria. Colorant transport was found on the pseudomonofilament and multifilament sutures between the first and the fifth day. Escherichia coli were transported on the majority of the multifilament sutures, although no transport was found on silk or polyester sutures. Bacterial transport was most often evident in tests using the motile Proteus mirabilis. All multifilament and pseudomonofilament suture designs allowed transport of colorants and bacteria to some degree. The movement of fluids and bacteria did not depend on the absorptive capacity of the sutures, coating, or the presence of an open suture end.

Tying a loop-to-strand suture: Is it safe?

This study was undertaken to evaluate the integrity of the loop-to-strand knot when tied with square and nonidentical sliding knots. The synthetic absorbable monofilament suture poliglecaprone 25 in 0 and 2-0 suture gauges was used in this experiment. For each suture gauge, 3 groups of knots were tested: (1) single strand-to-single strand, flat square knot, (2) loop-to-single strand, flat square knot, and (3) loop-to-single strand, nonidentical sliding knot. All knots were tied with 6 throws. The proportion of knots becoming untied was compared among the 3 groups for each suture gauge. Ultimate load required to untie or break knots within each group was also evaluated. The loop-to-strand knot performed well in both suture gauges tested as long as it was tied with a flat square knot. The loop-to-strand knot tied with a nonidentical sliding knot had an unacceptably high failure rate. The loop-to-strand termination of a continuous suture may be acceptable when tied with a 6-throw flat square knot but not acceptable if tied with sliding knots.

Biodegradation of Absorbable Sutures in Body Fluids and pH Buffers

Objective: This study measures the influence of body fluids on the loss of tensile strength of absorbable sutures in vitro. Methods: Nine synthetic absorbable sutures were incubated in different gastrointestinal fluids, as well as in blood and three buffers. Stretch tests were performed after days 0, 7, 14, and 21. Results: Tensile strength varied from 18.5 to 32.8 N, and elasticity varied from 9.5 to 51% of the initial length. The influence of pH, blood, and gastric juice was negligible on all sutures except PDS II^®. Except for Monocryl^®, all sutures, especially Polysorb^® and Vicryl^®, lost tensile strength much faster in bile, jejunal and pancreatic juices than in the corresponding buffers. Conclusion: The biodegradation of sutures varies greatly in different body fluids independent of differences in pH.

上顎洞前壁の復位をはかった上顎洞根治手術後における洞形態の変化‐吸収性縫合糸固定とチタンミニプレート固定との比較‐

上顎洞前壁の復位をはかった上顎洞根治手術後における洞形態の変化‐吸収性縫合糸固定とチタンミニプレート固定との比較‐

合成吸収糸による頚部皮膚縫合法

In neck surgery, the exposed scars of the primary suture should be fine for favorable cosmetic results. We previously used subcuticular and epithelial nylon sutures, but recently we have been using monofilament synthetic absorbable sutures (Polydioxanone; PDS-II®) in subcuticular closure to avoid indurations beneath the skin and late foreign body reactions. The scars of surgical incisions closed with PDS-II® were not inferior to those with nylon sutures, and we report below.In the prevention of hypertrophic scars, providing tensile relief and eliminating level differences of the skin are most important. The tensile strength of PDS-II® is retained for about 2 months, which is not long enough. Thus, subcuticular PDS-II® sutures require sufficient eversion to reduce scar stretching by providing dermal support for longer terms. We call this technique “hypereversion”. This technique does not require the control of degree of eversion according to patient age, and allows uniform sutures.Moreover, to get fine scars without suture marks, we are using film dressing (Op-site®) for wound fixation instead of epithelial suture in the early post operative period. When epithelial suturing is eliminated, level differences of the skin must be avoided in the subcuticular closure.

Poly( l-lactide/glycolide) suture: the effect of acute radiation

The physical properties of Poly( l-lactide/glycolide) indicate that the suture retains approximately 80% of its original strength at 3 months and 60% of its original strength at 6 months. This new long-term synthetic absorbable suture offers postoperative fascial strength for an extended period when compared to other available absorbables. Importantly, many women with gynecologic cancer will undergo radiation therapy during this interval. This report is intended to evaluate the effects of ionizing radiation on this suture. Methods. One lot (op strands) of size 1 PLG suture was used. Ten (10) strands were used for baseline study of out of package tensile strength. Eighty (80) strands were placed in a buffer solution (pH∼9.0) and incubated in an in vitro water bath∼48 h at 55°C to simulate 4 weeks in vitro residence time. Following this in vitro hydrolysis 20 strands were tested. Sixty strands were placed beneath a piece of fresh full thickness porcine skin and subcutaneous tissue and exposed to 3, 30, and 70 Gy. All samples were evaluated for breaking strength and elongation-at-break using an Instron tensiometer. Results. Analysis of variance performed at the different exposure level revealed no significant effect on tensile properties ( p>0.1). Conclusion. The tensile properties of PLG suture are not adversely affected by ionizing radiation. This long-term absorbable suture is an alternative for fascial closure when extended periods of support are necessary in patients destined to receive therapeutic ionizing radiation.

A randomised trial, conducted by midwives, of perineal repairs comparing a polyglycolic suture material and chromic catgut

Objective: to assess the effect of suture materials (an absorbable synthetic suture material versus catgut) used in perineal repairs undertaken by midwives who had been trained and accredited in repair techniques. Design: randomised controlled trial. Setting: tertiary obstetric hospital in Australia. Participants: 391 women with a live singleton birth at ≥34 weeks gestation, resulting from a spontaneous vaginal delivery and who required perineal repair due to either an episiotomy or first or second degree tear. Intervention: eligible women were randomly allocated for repair with either polyglycolic acid or chromic catgut. Main outcome measures: perineal pain and dyspareunia up to six months postpartum. Findings:of the 194 women allocated to polyglycolic suture 106 (55%) were primipara compared with 79 (40%) of the 197 women allocated to catgut. Due to this unexplained imbalance, odds ratios were estimated with and without adjustment for parity. The parity-adjusted odds ratios were little changed (<11%) from the crude odds ratios. Although there were no statistically significant differences, parity-adjusted odds ratios (aOR) suggest that compared with women sutured with catgut, women sutured with polyglycolic were less likely to experience perineal pain at Day 3 postpartum (aOR=0.70 95% confidence interval [95% CI] 0.46–1.08) but by six months postpartum were somewhat more likely to experience perineal pain (aOR=1.77, 95% CI 0.57–5.47), dyspareunia (aOR=1.21 [0.62–2.33] and require removal of a suture (aOR=2.61 95% CI 0.59–12.41). Conclusions: the finding of reduced short-term perineal pain in women repaired with polyglycolic compared with catgut is similar to that of a Cochrane Systematic Review. The possibility that polyglycolic is associated with worse longer-term outcomes has not been previously reported but is biologically plausible (catgut causes a local inflammatory reaction but is rapidly absorbed, while polyglycolic causes little inflammation but absorption takes longer). This trial also illustrates the difficulties of undertaking clinical research in a busy delivery ward.

Foreign Body Reaction to Bovine Pericardium: A Previously Unreported Complication of Pediatric Chordee Repair

Patching the shortened aspect of the corpora cavernosa is an established method of correcting penile curvature. Pericardium has been successfully used as an off-the-shelf material for tunica albuginea patching in the correction of Peyronie’s disease.1 While this technique is also applicable to the repair of congenital penile chordee, there is relatively little experience with its use in the pediatric population. We report a novel case of foreign body reaction to bovine pericardium in the penis that initially presented as a postoperative penile mass. CASE REPORT A 12-month-old boy underwent operative repair of a 30degree right lateral congenital chordee of the penis. Persistent curvature after complete degloving of the penile skin signified intrinsic corporal disproportion. To avoid penile shortening by plication we elected to graft the shorter concave aspect of the penile shaft. After urethral mobilization, the tunica albuginea of the right corpus cavernosum was incised, allowing straightening of the penis. The resultant defect was repaired with a 9 15 mm. elliptical patch of bovine pericardium (Periguard, Bio-Vascular, Inc., St. Paul, Minnesota). The patch was secured with 5-zero synthetic absorbable monofilament suture. Erectile function was well preserved as demonstrated by spontaneous straight erections postoperatively. A painless subcutaneous nodule was noted on the right side of the penile shaft 11 weeks later (fig. 1, A). No systemic reactions were evident, and observation was elected initially. However, the nodule failed to resolve during the next 6 months and, thus, prompted surgical exploration. The area of the previously placed pericardial graft was found to be occupied by a 1 cm. yellow mass (fig. 1, B). The mass was excised, leaving a defect in the tunica albuginea that was patched with an autologous dermal graft. Pathological evaluation of the lesion revealed xanthogranulomatous reaction, including foamy macrophages, chronic inflammation and foreign body giant cells (fig. 2). To date the cosmetic effect remains excellent, with continued straight spontaneous erections and no recurrence of the mass. DISCUSSION

The Scientific Basis for Selecting Surgical Sutures

The purpose of this study was to examine the handling properties of synthetic absorbable and monofilament polypropylene sutures made by two different manufacturers and to compare a subjective evaluation by surgeons to the results of standardized biomechanical performance tests. The surgeons' clinical subjective evaluation of the monofilament polypropylene sutures correlated with the results of the biomechanical performance studies, whereas the biomechanical evaluation of the two synthetic absorbable sutures detected notable differences in their performance. These distinct differences in biomechanical performance of the absorbable sutures did not alter their performance in the subjective clinical evaluation.