Synthetic Suture Material Research Articles

Easy and safe: A new surgical fixation -technique for acute and chronic anterior instabilities of the sternoclavicular joint: technique and results

Instabilities of the SC joint are a rare injury, accounting for only 3% of all injuries of the shoulder-girdle. While acute posterior dislocations are an emergency and require immediate surgical intervention, anterior instabilities (first and second degree according to Allman) can mostly be treated conservatively. Chronic and highly instable acute anterior instabilities often imposes a significant limitation on the lives of affected patients. Currently, there is no established therapeutic algorithm in place. This retrospective case series with prospective collection of data was performed at a level-I trauma centre. Patients treated surgically for anterior SC joint instabilities between January 2013 and December 2019 and with a minimum follow-up of 24 months were included. The injuries comprised of six acute anterior dislocations treated with tape-cerclage in a "figure-of-8" configuration; twelve patients with chronic anterior SC instabilities were treated with autologous tendon grafts. For one highly unstable chronic anterior instability in addition to the tendon graft synthetic suture material was applied. The clinical evaluation consisted of a physical examination and a standardized questionnaire, which included subjective and objective shoulder scores. Out of 24, 19 patients (79%) with an average age of 32 years ± 15 were available for follow-up. 63% of the patients were male. After a mean follow-up of 57 months, the mean age- and sex-adapted Constant-Murley Shoulder Score (CS) of acute anterior luxations amounted to 90 points ± 20, Nottingham Clavicle Score (NCS) to 81 points ± 22 and DASH Score to 11 points ± 18. Chronic anterior instabilities had a mean CS of 90 points ± 12, NCS of 83 points ± 17 and DASH Score of 4 points ± 5. The study shows a complication rate of 10%. Two patients underwent revision surgery. To conlude, monocortical SCJ fixation in a "figure-of-8" fashion presents a low risk for complication and a low revision rate and can achieve equally good functional outcome after the treatment of highly unstable acute and chronic anterior SCJ instabilities than other published techniques. Our approach presents less risk to the neurovascular structures of the mediastinum than other published techniques requiring bicortical drilling, therefore making the technique more accessible to hospitals without a cardiothoracic surgical background.

Review On Biological Properties of Suture Materials

Suture is a general term for all materials used to stitch torn tissues. Surgical sutures are imperative in management of surgical and traumatic wounds. Sutures are primarily used to oppose tissues together to assist and accelerate the recovery process after an incident or surgical operation. In addition, sutures also aid in obliteration of dead space, even distribution of stress on the incision line, and maintenance of adequate tensile strength throughout the critical wound healing process until appropriate tissue strength is achieved. Considering availability of a wide variety of suture materials, it’s important to know the differences between various sutures before making an informed decision. Suture material's overall performance is influenced by its physical qualities, handling features, and biological factors. The aim of this seminar paper is to give highlights on the biological properties of suture materials. Suturing is not simply about closing a wound; it is a skill that requires finesse and can significantly impact the healing process, reduce complications, and even affect long-term results. Suture selection involves the choice of both the appropriate type and size of suture material. Sutures may cause different host reactions in living tissues. While the suture remains in the tissue, it can trigger the inflammation cascade through different pathways such as degradation, a foreign body reaction, an allergic reaction, or abrasion. Natural suture materials such as catgut and silk are more immunogenic than synthetic materials because they are degraded by proteolysis in contrast to synthetic suture materials, which are degraded by hydrolysis. Therefore, surgery professionals should choose a suture material with good tissue acceptance.

Prospective, multi-centric, international, single-arm, cohort study to assess a synthetic polyamide suture material in oral surgery to close the mucosa - MUCODA study.

ObjectivesThe aim was to collect different clinical parameters systematically and proactively regarding safety, effectiveness, and performance of a nylon monofilament suture under routine clinical practice for oral surgery. MethodsThe study design was prospective, bicentric, international, single-armed, and observational. A non-absorbable suture was applied to close the mucosa after different dental surgical interventions. Main objective was the incidence of combined postoperative complications until suture removal. The 95 % Confidence Interval (Agresti-Coull method) was used to prove the non-inferiority with a pre-specified upper margin of 21.9 %. Secondary variables were intraoperative suture handling, patient pain and satisfaction, wound healing, aesthetic appearance, and bacterial contamination. Results105 patients were enrolled. Complication rate was low (1.9 %), 2 swellings occurred. Pain was present for 1.61 days ± 1.42 after various dental interventions with an average pain level of 20.98 ± 22.60 (VAS). Patients with impacted third molar extraction showed the longest pain duration (6 days) combined with the highest mean pain level of 35.33 ± 30.45 (VAS). Intraoperative suture handling was very good to excellent. Suture removal was done after an average duration of 7.56 ± 2.09 days. Patient's satisfaction was high, and an excellent wound healing was reported by the dentists. Aesthetic appearance only performed in implant patients was rated by oral surgeons with an average of 96.19 ± 3.79 points [min. 80 – max. 100] at 5 months postoperatively. Thread bacterial analysis showed that F. nucleatum was the most present species. ConclusionsOur findings indicate that the non-absorbable, nylon-based monofilament suture used is safe and quite suitable for oral mucosal closure after various dental surgical interventions such as tooth extraction, implant placement and impacted third molar extraction. Clinical significanceThis study showed the safe use of a non-absorbable, nylon-based monofilament suture for different oral surgical interventions under daily routine clinical practice.

Immediate Effects of the Self-Retaining Barbed Suture Material Application 
 for Gastrojejunostomy During Mini Gastric Bypass Laparoscopic Surgery

Background. The safety of self-retaining barbed suture material application when closing wounds of hollow organs and forming anastomoses remains controversial. Data on the use of self-retaining barbed suture material at the stage of a single anastomosis formation during mini gastric bypass laparoscopic surgery (mini gastric bypass - MGB) in the treatment of morbid obesity is scarce and includes both examples of suturing a technological hole after the implementation of a hardware technique, and totally hand-sewn intracorporeal knotless formation of a gastrojejunostomy.The aim of the study was to evaluate the immediate effects of single-row continuous sutures performed with self-retaining barbed unidirectional suture material for intracorporeal hand-sewn gastrojejunostomy during MGB.Methods. The study included 116 patients with grade II-III obesity who underwent MGB. The total duration of operations and the duration of the gastrojejunostomy stage, the volume of intraoperative blood loss, the frequency and severity of intra- and postoperative complications were prospectively studied in accordance with the unified classifications of Satava-Kazaryan and Accordion, respectively. The first group consisted of 56 patients; a conventional synthetic (polydioxanone) monofilament suture material was used for hand-sewn gastrojejunostomy in patients of this group. The second group consisted of 60 patients; gastrojejunostomy was performed with single-needle unidirectional self-retaining barbed absorbable polyester monofilaments in patients of this group. The study groups did not differ significantly in demographic characteristics, body mass index (BMI), the nature of comorbid pathology and the frequency of previous operations.Results. The use of unidirectional self-retaining barbed suture material for a hand-sewn intracorporeal single-row gastrojejunostomy in MGB was accompanied by a significant reduction in the total duration of interventions due to a reduced gastrojejunostomy stage if compared with the use of conventional synthetic monofilaments. The median volume of blood loss during operations did not exceed 50 ml and had no significant differences between groups. Intraoperatively, in patients of the study groups there were registered only complications of the first degree of severity, according to the Satava-Kazaryan classification, with a frequency of 6.7-8.9% (p = 0.737). In the postoperative period, the development of minor complications (first severity of the Accordion system) occurred in 19.6% and 16.7% of patients of the first and second groups, respectively (p = 0.810). The duration of hospital stay was 3.0 (2.5; 3.0) and 2.7 (2.7; 3.0) days in the first and second groups, respectively (р=0,790).Conclusion. The achieved reduced duration of MGB due to the reduced stage of gastrojejunostomy with self-retaining barbed unidirectional suture material, and comparable immediate effects of surgical treatment in patients of the first and second groups demonstrate significant outcomes. Further study is necessary to investigate long-term effects of the knotless suture application for a single anastomosis formation during MGB surgery.

The effect of argon plasma coagulation on surgical suture material

Introduction. In modern surgery, there are many types of different energy used to achieve hemostasis; one of them is the energy of argon plasma coagulation. However, the impact of energy affects not only the bleeding site; it also affects the stitches lying nearby the source of bleeding. The instructions for the use of a suture material or a coagulation tool do not describe the changes that may occur when they interact. A review of the literature found a small number of publications devoted to changes in the physical properties of suture material when exposed to it. This information is not sufficient to predict the effects of argon plasma coagulation energy on the suture material and, as a result, on wound healing or the quality of the postoperative scar.The objective was to determine changes in the biodestructive properties of synthetic absorbable suture materials with argon plasma coagulation in an in vivo experiment.Methods and materials. In the experimental study, the results of biodegradation of monofilament and polyfilament sutures after exposure to argon plasma coagulation energy were analyzed in comparison with control samples in the body of laboratory mice.Results. It can be unequivocally stated that the effect of argon plasma coagulation energy has an effect on the rate of biodegradation of both monofilament and polyfilament synthetic filaments implanted in muscle tissue.Conclusions. Suture material exposed to argon plasma coagulation may not meet the terms of partial or full biodegradation stated by the manufacturer, which may affect the quality of scar formation.

The effect of medical grade honey on tensile strength, strain, and Young's modulus of synthetic absorbable suture material used in equine surgery.

Medical grade honey (MGH) has been introduced as a protective measure against surgical site infections in equine surgery, but the effect on suture material has not been investigated. To evaluate the effect of MGH on the tensile properties of three synthetic absorbable suture materials. In vitro experiments. Ten strands of Polydioxanone USP 2 (PD2), Polyglactin 910 USP 2 (PG2) and Polyglecaprone USP 2-0 (PC2-0) were incubated 1, 7, 14, 21 and 28 days in MGH, phosphate-buffered saline (PBS), equine plasma (EP) and MGH mixed with equine plasma (HP). Mechanical testing was performed recording maximum load at failure (N), strain at failure and Young's modulus (N/mm2 ). The results were reported from a Welch or regular ANOVA. PD2 in MGH had a significantly higher tensile strength compared to PD2 in EP (p < 0.05, mean difference (md) = 16.95 N, CI95% (9.19-24.70 N)) and PBS (p < 0.05, md = 14.48 N CI95% (6.73-22.23 N)) on day 7 and the remaining time points. PG2 incubated in MGH had a significantly higher tensile strength compared to EP (p < 0.05, md = 69.28 N CI95% (64.16-74.40 N)) and PBS (p < 0.05, md = 56.90 N CI95% (51.78-62.02 N)) until day 28. PC2-0 incubated in MGH had a significantly higher tensile strength compared to EP (p < 0.05 md = 12.40 N CI95% (4.59 N-20.20 N)) and PBS (p < 0.05 md = 11.23 CI95% (3.42-19.03 N)) on day 7 and the remaining time points. The sutures were unloaded during incubation and a single cycle to failure test was only performed, which does not reflect the in vivo environment where shear forces are present. MGH did not negatively affect the tensile strength of the suture material and can safely be applied in contact with suture materials commonly used in equine surgery.

Does suture material affect cesarean section scar healing?

Background: Sutures are an essential part of any major surgery which serve to hold opposing tissues together and accelerate the healing process, resulting in decreased scarring of the affected areas. In the past, gold, silver, iron, and steel wires, dried animal gut, silk, and plant fibers (e.g., linen, cotton) have been used as suture materials. Obstetricians commonly use synthetic absorbent sutures for uterine closure during CS. This study aim to evaluate the effects of different synthetic absorbable suture materials on cesarean scar defect formation.Methods: After excluding patients who did not meet inclusion criteria and those who declined to participate, the patients were randomly divided in to 2 groups: - study group І: - 35 patients and study group II: - 35 patientsPatients were subjected to the following: Ultrasound evaluation Ultrasound was done to ensure viability, determine the gestational age, the position of the placenta, the presenting part, the amniotic fluid and the estimated fetal weight using convex transducer of (Samsung Medison H60, Korea & 50/60 HZ).Results: Regarding demographic data of the studied patients, Age, gestational age and BMI there were no significant difference between both groups. Regarding time of operation and type of anesthesia there were no significant difference between both groups. There was no significant difference in the preoperative, post-operative and delta Hb concentration between both groups. Regarding post-operative pain, there was no significant difference between both groups. Regarding post-operative hospital stay was no significant difference between both groups. Regarding myometrial thickness, total and residual myometrial thickness was significantly thicker in group II compared to group I.Conclusions: Our results showed that monofilament sutures reduced pathological inflammation during wound healing without increasing costs, operation time, or intraoperative complication rates; resulting in improved uterine scar recovery; and potentially reduced CSD. These findings suggest that gynecological sequelae due to CSD and serious obstetric complications that may occur in subsequent pregnancies can be reduced.

Impact of Fluoridated Mouthwashes on Strength and Durability of Three Different Synthetic Absorbable Suturing Materials: An In Vitro Study

The aim of the current in vitro research was to assess the effect of fluoride-containing mouthwashes on the strength and durability of three different synthetic absorbable suturing materials. Three types of synthetic absorbable suture materials were employed in this research, and every group comprised 20 suture samples. These include group I: Polyglactin 910, group II: Polyglycolic acid, and group III: Poliglecaprone 25. This research utilized 4-0 gauge sutures. Each example was tied using a square surgeon's knot about elastic rubber tubing. The biology of the oral milieu was replicated in vitro through the use of artificial saliva. The medium that was subjected to test prior to inclusion were 0.2% chlorhexidine gluconate as well as 0.044% sodium fluoride. The tensile strength of the specimen suture materials was subjected to test at a particular time intervals: prior to immersion, the 1st day, the 7th day, as well as the 14th day after immersion. Tensile strength was evaluated using a Universal Ultra Test machine. Post-immersion in 0.2% chlorhexidine gluconate mouthrinse, the mean tensile strength of polyglactin (PLG) 910 sutures was 24.48 ± 0.08 at pre-immersion and 4.36 ± 0.01 on the 14th day. The mean tensile strength of polyglycolic acid (PGA) sutures was 24.04 ± 0.26 at pre-immersion and 2.10 ± 0.02 on the 14th day. The mean tensile strength of Poliglecaprone 25 sutures was 23.82 ± 0.11 at pre-immersion and 1.34 ± 0.08 on the 14th day. Post-immersion in 0.044% sodium fluoride mouthrinse, the mean tensile strength of PLG 910 sutures was 24.18 ± 0.02 at pre-immersion and 5.12 ± 0.21 on the 14th day. The mean tensile strength of PGA sutures was 24.88 ± 0.34 at pre-immersion and 4.58 ± 0.10 on the 14th day. The mean tensile strength of Poliglecaprone 25 sutures was 24.48 ± 0.27 at pre-immersion and 5.08 ± 0.14 on the 14th day. A statistically noteworthy difference was noted amid the three types of sutures at dissimilar time points evaluated with p <0.001. The current research arrived at a conclusion that there is a significant difference between the mean tensile strength and purpose of the medium used for immersion as well as the tenure. Polyglactin suture material exhibited superior strength as compared to PGA and poliglecaprone suture substances following immersion in the investigational media. Suture materials are employed in the closure of incised flaps, to aid healing by primary intention, along with control of bleeding. In oral as well as periodontal surgery, the right choice of sutures is very important for good healing. Suture choice for the mouth should be influenced by the requirements of the anticipated repair and the surgeon's fondness.

Vesicovaginal fistula with bladder and vaginal stone.

IntroductionIn developing countries, Vesico-vaginal fistula (VVF) results following obstetric trauma or iatrogenic during hysterectomy. Large calculus associated with VVF is relatively rare, with the risk factor are presence of foreign body, urinary tract infection, and prolonged duration of disease. Most bladder stones can be found among patients who are bedridden, indwelling urethral catheter, bladder outlet obstruction, infection, and other similar characteristic. We report a case of VVF with bladder and vaginal stone in 37 years old woman and reviews the evaluation and treatment and highlights the role of the healthcare team in managing patients with this condition.Presentation of caseA 37-year-old, P2A0, woman with a history of hysterectomy three years ago. Intermittent small amounts of watery vaginal discharge developed 1,5 years after the operation. A physical examination revealed mild tenderness over the suprapubic area and no evidence of uterine prolapse. Cystography computed tomography scan with contrast confirmed a fistula vesicovagina with a connection between posterosuperior wall of vesica urinaria and anterosuperior wall of vagina with vesicolithiasis, size 15 × 26 × 14 mm and two vaginal stone with size of 7 × 12 × 17 mm and 4 × 4 × 5 mm. Cystoscopy revealed a grayish stone identified in supratrigone with size of 30 × 12 mm.DiscussionA hanging intravesical stone on the dome of urinary bladder is scarce, possibly caused by any synthetic and non-absorbable suture material inside of the bladder were encrusted forming a bladder stone. Important risk factors known, which is specific in developing countries, are poor socioeconomic status, malnourishment, low literacy rate, early marriage and childbearing, and inadequate obstetrical care.ConclusionAlthough the incidence of VVF accompanied by hanging vaginal stone and a large bladder stone is scarce, reports of any case regarding this study can be beneficial to other studies. Due to its harmful effect, the usage of non-absorbable sutures material during surgery isn't suggested. Hence, the absorbable suture material usage with careful dissection is suggested for any gynecological or pelvic surgery.

Multi‐ligamentous injury of the carpus with dislocation of the ulnar styloid in a dog

AbstractA 3‐year‐old mixed‐breed dog was presented with acute onset of non‐weight bearing right thoracic limb lameness. Radiographs revealed dislocation of the ulnar styloid and a small slab fracture of the medial cortex of the distal ulna. Moderate medial and mild lateral instability without hyperextension were detected, and carpal bone fractures were excluded on stress radiographs and computed tomography. The surgical repositioning of the ulnar bone revealed multiple torn ligaments. To reinforce primary repair, the collateral ligaments were augmented medially and laterally using screws, washers and synthetic suture material. Postoperatively, external coaptation, followed by a soft neoprene brace, was used for further rehabilitation. Seven months postoperatively, the dog exhibited pre‐traumatic function. There is no proper classification for multi‐ligamentous injuries, and little is known regarding the long‐term outcomes and limitations of primary carpal ligament repair. In this case, medial and lateral ligament prostheses provided a feasible treatment option with excellent outcomes.

Fast Track Surgery in laparoscopic treatment of inguinal hernias

Background. Minimally invasive surgical techniques for inguinal hernia repair reduce the body’s overall stress response to surgical tissue damage, the risk of complications, the percentage of postoperative acute and chronic pain, recovery time.&#x0D; Objective. To improve short-term (acute inguinal pain in the early postoperative period) and long-term (chronic inguinal pain in the long-term follow-up) results of surgical treatment of patients with acquired inguinal hernia by using the modified (sutureless, without mesh fixation) laparoscopic technique of transabdominal preperitoneal hernioplasty (TAPP) with application of Fast Track Surgery guidelines.&#x0D; Materials and methods. The retrospective clinical study included 124 patients aged 18 to 88 years (mean age – 46±2.1) with primary unilateral inguinal hernias who were operated on the clinical bases of the Department of Surgery and Vascular Surgery of Shupyk National Medical Academy of Postgraduate Education. The observation period was 3 years. Modified TAPP was performed in 78 patients (spinal anesthesia, local anesthesia of trocar wounds, terminal peritoneal anesthesia, preperitoneal infiltration of affected inguinal region dissection by local anesthetics, using of anatomical 3D mesh, sutureless restoration of peritoneal defect by electric welding method) and Lichtenstein technique was performed in 46 patients. The peritoneal defect in the main group after implant placement was restored by spot welding.&#x0D; There was experimental study before proceeding the clinical study. The experimental section of the work included 12 rabbits weighing 1.95-3.75 kg (average weight – 2.30±0.52). Each animal was cut peritoneum in three places on both sides of laparotomy with next reconstruction of the defect on one side by welding, and on the other – by suturing with synthetic suture material.&#x0D; Results and discussion. In biological samples from experimental animals, there was decreasing of number of live mesotheliocytes which did not increase the severity of the inflammatory reaction (p˂0.001). A statistically significant difference was observed in the welded scars with higher intensity of collagen formation than in the ligature scars, which provided greater strength of the tissue connection.&#x0D; There was a reduction in the patient’s length of stay in the hospital in 4.2 times in the group of modified technique. There was a reduction in the period before the ability to perform professional duties in 3.4 times in the group of new surgical method. There was no significant difference in the levels of postoperative complications (p=0.036) and re-operations due to complications (p=0.023). In the group of modified surgical treatment there were significant lower rates in the indicators of pain at rest (p&lt;0.001), pain during exercise (p&lt;0.001), recurrence rates (p&lt;0.001). There was a decrease in the need for analgetics in the main group in the early postoperative period (p˂0.001) and a reduction in the risk of prolonged inguinodynia (p˂0.001).&#x0D; Conclusions. The obtained results demonstrate the effectiveness of the use of modified laparoscopic transabdominal preperitoneal hernia mesh repair for primary unilateral inguinal hernias with using Fast Track Surgery protocols with regard improving quality of life of patients in the early and long postoperative period and reduction of the risk of recurrence.

Continuous versus interrupted sutures for repair of episiotomy using monofilament versus synthetic absorbable multifilament suture materials: a randomized controlled trial

Objective To compare different repair techniques and different suture materials for episiotomy. Background Care of the perineum during and after childbirth has been a topic of considerable interest to all involved for many years. A considerable amount of research has been carried out in the area of perineal care, particularly in relation to the practice of performing episiotomy and to the methods of suturing. Patients and methods A total of 90 primigravidae were admitted for labor and underwent a mediolateral episiotomy after vaginal delivery. They were randomly allocated into four groups in which continuous and interrupted episiotomy repair techniques were performed under two different types of suture materials, that is, monofilament type in the form of poliglecaprone 25 and multifilament type in the form of polyglactin 910. Perineal pain during different activities on the first and seventh day postpartum was questioned by visual analog scale, and the presence of perineal pain after 3 months of delivery, repair time, amount of suture material, and episiotomy complications were investigated in each group. Results The results of the present study showed that the assessments of pain in the first day and after 1 week in movement, repose, sitting, urination, and defecation were insignificant regarding suture techniques and suture materials. The repair time and the length of suture material were statistically less in the continuous technique groups. The type of suture material did not show significant effect on either the length of suture material used or the episiotomy repair time. Conclusion The use of continuous technique of episiotomy repair is better than interrupted technique, because the former is quicker and cheaper as less suture material is used with no differences on either short-term or long-term morbidity.

Clinical and laboratory investigation on the recurrence of the umbilical hernia after herniorrhaphy in bovine calves

This study was performed to investigate the recurrence of the umbilical hernia in bovine calves at Veterinary Teaching Hospital (VTH), Bangladesh Agricultural University, Mymensingh. A total of 34 animals were admitted to VTH diagnosed to have the umbilical hernia, among them 13 were recurrent cases. The diagnosis of umbilical hernia was based on the disease history, clinical signs, palpation, needle exploration, and auscultation. The risk factors like age, sex, breed, body weight, the season of affection, size of the hernial ring, suture materials, error in suture patterns and involvement of infections in the recurrence were considered. Infected samples were collected from recurrent patients with infected umbilicus region, and subjected to bacteriological analysis. We found the recurrence percentage was higher in the crossbred (44%) than that in the indigenous (22.22%) calves. It was also observed that recurrence percentage was higher in male (42.11%) than those in female (33.33%) patients. The recurrence percentage was also higher in calves aged below three months (40.74%) than the calves of above three months (28.57%). It was found that recurrence percentage was most frequent in summer (46.15%) and the least in the winter (30%). Among 13 recurrent bovine calves after herniorrhaphy, three calves returned to VTH with umbilical abscess, six calves recurred due to non-infectious causes like failure of suture materials, errors in suture pattern or management fault and 4 calves recurred with both umbilical abscess and non-infectious causes. From this study, it may be concluded that synthetic absorbable suture materials with secured suture pattern and good postoperative management may help in reducing the recurrence of an umbilical hernia.&#x0D; J. Bangladesh Agril. Univ. 16(3): 464–470, December 2018

A clinical study and different modalities of management of ventral hernias

Background: Ventral hernias are a common problem encountered by the surgeons. Patients developing hernias become restricted from work or usual activities as the hernia enlarges and this demands surgical repair. The objective of this study is to evaluate the predisposing factors, the different modes of presentation, the different methods of surgical repair including the newer methods.Methods: A prospective random study done at Alluri Sita Rama Raju Academy of Medical sciences, Eluru, where in 50 cases of ventral hernias were randomly selected. A thorough case history taken as per the proforma enclosed and relevant investigations were done following which a selective surgical treatment such as anatomical repair and mesh repair were used. Anatomical repair was mainly considered in pediatric and infected cases and the remaining with open and laparoscopic mesh repair.Results: Majority of ventral hernias were seen in the age group of 21 to 60 years with a major female preponderance in umbilical, paraumbilical and incisional hernias, and epigastric hernias common in males. The common predisposing factors identified were previous surgeries, followed by anaemia, multiparity. Majority patients presented with mass or swelling over the abdomen which were reducible. The lower midline incisions were the most common cause for incisional hernias. Most of the patients had a fair preoperative presentation. In this study anatomical and mesh repair (open and laparoscopic) were done. 7 cases lost follow up and no recurrences noted.Conclusions: Among the ventral hernias infraumbilical incisional hernias were common with majority being gyneacological and obstetric procedures. Maximum cases were repaired with Open mesh repair (onlay &gt;inlay) followed by laparoscopic and anatomical repair. With the good knowledge of anatomy, good relaxed anaesthesia and improved surgical skills, the use of synthetic suture and prosthetic material, coverage with antibiotics, post-operative care the outcome of treatment for hernia has improved with insignificant recurrence.

Arthroscopic Synthetic Augmentation in Acute Partial Injury of the Anterior Cruciate Ligament

Acute partial injury of the anterior cruciate ligament (ACL) is a challenging condition without a standard treatment. Although ACL reconstruction provided a better outcome previously, recent studies have shown that preserving the ACL stump yields promising results in terms of better vascularization, proprioception, and ligamentization. ACL augmentation is becoming more popular. Therefore, we propose a technique to augment an acute partial ACL injury with synthetic suture material to stabilize the unstable cruciate ligament. The suture material acts as a structural tie for ACL healing without any need for external immobilization. This technique is beneficial in preserving the natural ACL stump and autograft, creating a narrow bone tunnel, and providing a good cosmetic outcome.

Ethical considerations in the use of biopolymer sutures

Biopolymer suture materials, namely gut and silk, represent under-recognized sources of potential ethical conflict in the informed consent of surgical patients. Objections to acceptance of such products may be made on both religious and secular grounds, and should not be discounted by assumption. Consistent with contemporary medical ethics, informed consent thus ought to include disclosure of use and source of these animal-derived products, as is the case with dressings and prostheses. Potential substitutes may be found in synthetic suture materials suitable for both absorbable and permanent placement, providing practical options to the conscientious physician.

Hemangiosarcoma Associated with Polypropylene Suture in a Cat

Background: Sutures plays an important role in wound repair by providing hemostasis and support for healing suture. Synthetic non-absorbable like polypropylene suture materials induce minimal tissue reaction. Polypropylene has not been associated to neoplasms in domestic animals. The aim this study is to describe the first case of polypropylene suture induced hemangiosarcoma in an abdominal wall of a feline.Case: A 13-year-old female domestic shorthair cat was presented with a ventral abdominal subcutaneous mass. Clinical examination revealed a firm, rough, and irregular, approximately 6 x 4 cm subcutaneous mass involving the caudal ventral abdomen. A complete blood (cell) count (CBC) was within normal limits. Leukemia and FIV tests were negative; andthe results of a chemistry panel revealed elevated creatinine (valor: 2.0 reference range: 0.5-1.9). Abdominal ultrasound revealed a large mass of mixed echogenicity in the mid-ventral abdomen cranial to the bladder, measuring approximately 6 x 4 cm in the middle line with suture deeply embedded within mass suggesting foreign body reaction or neoplasm. There was evidence of sutures (hyperechoic lines) along the caudal abdominal wall extending into the mass. Records indicated that ovariohysterectomy procedure was performed 12 years previously at the same clinic and the closure of the abdominal wall was made with polypropylene sutures. No other abdominal surgery was performed in this cat. A fine-needle aspirate of the mass and contrast-enhanced computed tomography was not performed due to owner’s finance restrains. The catwas referred to surgery and the mass was excised. No evidence of metastasis was noted during surgery. Histologically, the neoplastic cells were oval to round with granular cytoplasm and vesicular nucleus and exhibited moderate cellular and nuclear pleomorphism. A diagnosis of abdominal wall hemangiosarcoma was made with suture deeply embedded within mass. Surgical margins were clear. Chemotherapy was indicated, but the owner declined due to financial reasons. This is the first polypropylene suture mass associated hemangiosarcoma in cats.Discussion: Hemangiosarcoma is a malignant neoplasm of vascular endothelial cells origin and it may be associated with chronic inflammation and neoplastic transformation. It was reported in previous studies, and it could be a hypothesis for the presented clinical case. There are two cases described in the literature of abdominal wall tumor associated with foreignbody and exuberant inflammatory response in cats using different types of suture; one case is a steel staple developing hemangiosarcoma and the other is polyester sutures developed fibrosarcoma. The present study shows a primary hemangiosarcoma diagnosed several years after closure of abdominal wall using polypropylene sutures in a female cat. Polypropylene is a monofilament suture that create less tissue-drag and induces less inflammation than multifilament sutures and is the preferred suture to close abdominal wall. Cats demonstrate a peculiar predisposition to neoplasms at the site of injury. Although the pathogenesis is still unclear, the introduction a “foreign body” may cause inflammatory process that act as a stimulus to neoplasia formation. We believe that polypropylene was the foreign material that may have played arole in tumor development in this case and it has not been reported before. Polypropylene sutures were found on gross examination of excised material. Any uncoated braided non-absorbable material located deeply in tissues may evoke a chronic inflammatory response (granuloma). A granuloma may evolve to malignancy in some cats. Despite polypropylenematerials induce minimal tissue reaction, it may be associated to neoplasm.Keywords: polypropylene suture, hemangiosarcoma, cat, tumor induced by foreign body.

Does Suture Material Affect Uterine Scar Healing After Cesarean Section? Results from a Randomized Controlled Trial

ABSTRACTBackground: Impaired healing of the uterine scar after cesarean has been associated with adverse gynecological and obstetric outcomes. Although a large number of studies have been conducted on the events leading to this, information obtained from prospective randomized studies examining the role of suture material in the formation of cesarean scar defect (CSD) is lacking. Objective: To evaluate the effects of synthetic suture materials on CSD formation. Study design: We performed a two-arm 1:1 randomized study in women with singleton pregnancies undergoing elective primary cesarean delivery after the 38th week of gestation. Uterine scar closure was performed using synthetic absorbable monofilament and multifilament sutures. The primary outcome was residual myometrial thickness (RMT) in the area of the scar, measured by transvaginal ultrasound 6–9 months after birth. Secondary outcomes included differences in mean operative time, mean estimated blood loss at the time of surgery, and the rates of postoperative gynecological sequelae. Results: Complete follow-up was obtained from 94 (88%) of 107 participants. RMT was thicker in the monofilament compared to the multifilament suture group (5.5 ± 2.24 vs. 4.18 ± 1.76, p = 0.01). Hemoglobin delta was higher in the monofilament suture group (1.59 ± 0.96 vs. 1.25 ± 0.60, p = 0.04). There was no statistically significant difference between the monofilament suture and multifilament suture groups in terms of gynecological sequelae. Conclusion: Closure of the uterine scar with monofilament suture has a positive effect on scar healing and increases RMT thickness.

Sustainable Postoperative Care After Cesarean Section

Rationale: puerperal endometritis is the major cause of formation of incompetent uterine scar and spread of infection. By contrast, reparative processes concerning uterine walls are the basis for formation of a competent uterine scar. In the past decades, there have been observed significant changes in the clinical course of puerperal endometritis. Apart from other factors, they are caused by improper antibiotics prophylaxis and antibiotic treatment. The key factors responsible for uterine scar incompetence also include improper surgery methods, namely: application of uninterrupted, continuous suture of uterus, reactogenic material, inappropriate hemostasis, pathological blood loss, surgery duration over two hours, using technique of manual fetal exteriorization.&#x0D; The aim of the present research is to identify a group of maternity patients that could avoid being administered perioperative antibiotic prophylaxis and the further antibiotic therapy on condition that their lower uterus segments are processed with interrupted sutures. It also involves the assessment of the early postoperative care period as well as eliminating possible complications. Materials and methods: The article analyses a group of 63 maternity obstetrics patients in early postoperative care period. They had their lower uterus segments processed with interrupted sutures. In all cases we used peritonization with help of plica vesicouterina. Antibiotic prophylaxis was avoided in both perioperative and early postoperative care periods. The article also presents the lab test values, data on thermometry and ultrasound diagnostic. The latter analyzed the following: length, width, thickness and the size of uterus, thickness of the front part of the uterus in the scar area, echoicity and echo structure of the mentioned area. Ultrasound examination allows us to estimate the uterus size, the scar condition, possible pathologic elements in the uterus body. The article also presents data on physical examination and bacteria culturing of the content of the uteri cavity during three days.&#x0D; The results: the complications were not presented by such nosological forms as endometritis or postoperative peritonitis, as well as inflammatory urinary conditions. No cases of any partial suture line disruption have been observed on the anterior abdominal wall or hyperthermia over 37,5 within the first three days of the postoperative period.&#x0D; Conclusions: during the rehabilitation period for the lower uterus segments by using synthetic suture material for the low-risk group of obstetrics patients it is not necessary to provide antibiotics prophylaxis and antibiotic treatment in the case of a planned or postponed caesarian section&#x0D; &#x0D;

Polypropylene mesh seeded with fibroblasts: A new approach for the repair of abdominal wall defects in rats.

The purpose of study was to develop bioengineered scaffolds by seeding primary mouse embryo fibroblast cells (p-MEF) on polypropylene mesh and to test its efficacy for the repair of abdominal wall defects in rats. The study was conducted on 18 clinically healthy adult Wistar rats of either sex. The animals were randomly divided into two equal groups having nine animals in each group. In both the groups a 20mm×20mm size full thickness muscle defect was created under xylazine and ketamine anesthesia in the mid-ventral abdominal wall. In group I the defect was repaired with polypropylene mesh alone and in group II it was repaired with p-MEF seeded polypropylene mesh. Matrices were implanted by synthetic absorbable suture material (polyglycolic acid) in continuous suture pattern. The efficacy of the bio-engineered matrices in the reconstruction of full thickness abdominal wall defects was evaluated on the basis of macro and histopathological observations. Macroscopic observations revealed that adhesions with skin and abdominal viscera were minimum in group II as compared to group I. Histopathological observations confirmed better fibroplasia and collagen fiber arrangement in group II. No recurrence of hernia was found in both the groups. Hernias are effectively repaired by implanting polypropylene mesh. However, this work demonstrates that in vitro seeding of mesh with fibroblasts resulted in earlier subsidization of pain, angiogenesis and deposition of collagen, increased thickness of matrices with lesser adhesions with underlying viscera. On the basis of the results p-MEF seeded mesh was better than non-seeded mesh for repair of abdominal wall defects in rats.