Uncoated Sutures Research Articles

The Effect of Fascial Closure With Triclosan-Coated Sutures on the Incidence of Abdominal Wall Dehiscence: An Individual Participant Data Meta-Analysis.

Wound closure with triclosan-coated sutures (TCS) appears to reduce the risk of surgical site infection (SSI). Because there is a strong association between postoperative SSI and the development of acute abdominal wall dehiscence (AWD) after laparotomy, we hypothesized that the use of TCS for wound closure after laparotomy may also reduce the risk of AWD. The MEDLINE, Embase, and CENTRAL databases were searched from their inception to 01 November 2022. Randomized trials that compared the use of TCS with identical but uncoated sutures for fascial closure were eligible if they could provide individual participant data (IPD) on AWD. From these trials, we only included in the analysis those subjects who underwent open abdominal surgery. The primary outcome was the incidence of AWD within 30days postoperatively, requiring emergency reoperation. The certainty of evidence was assessed using the GRADE methodology (PROSPERO: CRD42019121173. We identified twelve eligible trials. Eight studies shared IPD. The incidence of AWD within 30 days after surgery was 27/1,565 (1.7%) in the TCS group vs. 40/1,430 (2.8%) in the control group (Relative Risk: 0.70 [95% confidence interval (CI) 0.44-1.11, I 2 = 0%, τ2 = 0.00]). The certainty of evidence was moderate after downgrading for imprecision. The incidence of incisional SSI was 163/1,576 (10.3%) vs. 198/1,439 (13.8%), RR 0.80 (95% CI 0.67-0.97). We found no conclusive evidence to support the use of triclosan-coated sutures for the prevention of acute abdominal wall dehiscence after laparotomy. In these selected studies, a significant reduction in incisional SSI was observed.

Safety and Effectiveness of Triclosan-Coated Polydioxanone (PDS Plus) versus Uncoated Polydioxanone (PDS II) Sutures for Prevention of Surgical Site Infection after Hypospadias Repair in Children: A 10-Year Single Center Experience with 550 Hypospadias.

Triclosan is an antiseptic substance that has been shown in preclinical studies to reduce bacterial load in the wound and slow bacterial growth by inhibiting fatty acid synthesis. It is claimed that the coating protects against colonization of the tissue around the suture. This study aimed to compare the safety and efficacy of triclosan-coated polydioxanone versus uncoated polydioxanone sutures for the prevention of surgical site infections (SSIs) following hypospadias repair in children. The medical records of 550 children who underwent hypospadias repair between 1 January 2014 and 31 December 2023 were retrospectively analyzed. The patients included in the study were divided into two groups. The first group consisted of the patients in whom polydioxanone (PDS II) was used (n = 262), while in the patients of the second group (n = 288), triclosan-coated polydioxanone (PDS Plus) was used for hypospadias repair. Secondary outcomes were defined as the occurrence of early and late complications, the number of readmissions within 30 days after surgery (ReAd), unplanned return to the operating room (uROR), and repeat operations. The median age of all children enrolled in the study was 16 (IQR 14, 20) months. The patients in whom PDS Plus was used for hypospadias repair had a significantly lower number of SSIs than the patients in whom PDS II was used (n = 18 (6.9%) vs. n = 4 (1.4%), p < 0.001). Wound infection led to wound dehiscence in 10 of 18 patients from the PDS II group, while all four wound infections from the PDS Plus group led to wound dehiscence (p = 0.07). The number of postoperative urethrocutaneous fistulas was significantly lower in the patients in whom PDS Plus was used (13.7% vs. 8.3%, p = 0.042). The incidence of late complications did not differ between the study groups: meatal stenosis (p = 0.944), residual chordee (p = 0.107), urethral stricture (p = 0.196), scarring (p = 0.351) and urinary discomfort (p = 0.713). There were no cases of uROR in either group. The ReAd rate was low in both groups (n = 5 (1.9%) vs. n = 2 (0.6%), p = 0.266). The frequency of reoperations was lower in the group of patients treated with PDS Plus than in the group of patients treated with PDS II (11.1% vs. 20.6%; p = 0.03). The use of PDS Plus in hypospadias surgery significantly reduces the incidence of SSI, postoperative fistulas, and reoperation rates compared to PDS II.

Assessment of Mechanical Properties and Antimicrobial Effects of Hyaluronic Acid Coating on Absorbable Suture Material: An In-vitro Study

Introduction: The use of absorbable suture materials in surgical procedures is a critical aspect of wound closure and tissue repair. In recent years, there has been growing interest in exploring the potential benefits of incorporating Hyaluronic Acid (HA), a naturally occurring biopolymer, into these sutures. By shedding light on the interactions between HA and absorbable sutures, the present study seeks to provide valuable insights that could enhance the quality of surgical wound management. Aim: To assess the mechanical properties and antimicrobial effects of HA-coated and uncoated absorbable suture material. Materials and Methods: The in-vitro study was conducted at Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India in a year 2022. A total of 70 samples of HA-coated and uncoated Vicryl 4-0 suture material were tested for tensile strength using an Instron machine. An anti-bacterial effect against Pseudomonas aeruginosa and Streptococcus mutans was assessed using a Mueller Hinton agar (MHA) plate, and the zone of inhibition was measured. Additionally, both the uncoated and HA-coated Vicryl 4-0 suture materials were analysed under the Scanning Electron Microscope (SEM) to determine the surface characteristics. An independent t-test was used to compare the tensile strength of coated and uncoated suture materials. Results: The mean tensile strength of uncoated and HAcoated suture material was 6.47±0.23 MPa and 3.78±1.02 MPa, respectively. The difference between both groups was statistically significant (p&lt;0.05). For Pseudomonas aeruginosa and Streptococcus mutans, the zone of inhibition was 8.0±0.5 mm in diameter and 9±0.5 mm in diameter, respectively, around coated Vicryl 4-0 suture material, whereas no zone of inhibition was observed for both Pseudomonas aeruginosa and Streptococcus mutans around uncoated suture material. SEM analysis showed superior surface characteristics of HA-coated suture thread when compared to uncoated suture thread. Conclusion: HA-coated suture material does not exhibit superior tensile strength when compared to the uncoated suture material. However, HA-coated suture material has potent antibacterial effects against Pseudomonas aeruginosa and Streptococcus mutans. Additionally, SEM analysis showed improved surface characteristics in favour of the coated suture material.

Evaluation of Microbial Adherence on Antibacterial Suture Materials during Intraoral Wound Healing: A Prospective Comparative Study.

To assess the efficacy of antiseptic-coated silk sutures with triclosan-coated polyglactin 910 suture in reducing bacterial colonization after oral surgical procedures. The patients who required multiple sutures after surgical procedures in the mandible were the study subjects. The sites of suturing were divided into three groups. Group A - surgical site receiving black-braided silk suture (control group). Group B - surgical site receiving triclosan-coated Polyglactin 910 suture (experimental group). Group C - surgical site receiving antiseptic-coated silk suture (experimental group). Evaluation was done on the 3rd postoperative and 7th postoperative day. Microbial adherence was evaluated by microbiological study. The mean comparison of microbial count between 3rd and 7th post-op day in the three groups shows an increased microbial colonization in the control group when compared with the experimental groups. The combined mean microbial adherence in the three groups showed microbial count in the uncoated silk suture (group A) as 10.35 ± 3.74, triclosan-coated suture (group B) as 6.28 ± 2.17 and iodoform + calendula oil-coated suture (group C) as 7.1 ± 2.02 which is statistically significant (p < 0.05). The present research concluded that the pomade-coated silk suture is as efficient as triclosan-coated VICRYL PLUS Polyglactin 910 sutures in reducing the bacterial colonization in intraoral wound healing. The pomade (iodoform + calendula oil) may be advocated in the field of oral and maxillofacial surgery for impregnating the suture materials which act as an antiseptic agent and a promoter of wound healing which is easily accessible and also cost-effective.

Collagen Coating Improves In Vitro Tenocyte Interaction With Suture Tape for Ligament Augmentation

InternalBrace ligament augmentation is a recent advancement in the treatment of ligament instability, with demonstrated safety and clinical effectiveness for lateral ligament reconstruction. There are multiple commercially available suture tapes made of a variety of materials whose biological properties have not been well evaluated. These properties may affect the quality of reparative tissue given the intimate apposition of the ligament to the augment. This study explores tenocyte viability, adhesion, and proliferation to 4 suture tapes. Four suture tapes were studied: 1 with a collagen coating, 1 with a silicone coating, and 2 uncoated. The sutures were seeded with tenocytes and viability, adhesion and proliferation were evaluated over a 14-day period (n=12). Initial viability was highest on the collagen-coated suture tape (96.7±3.6%) and lowest on the silicone coated (54.7±23.0%). The highest live cell density after 14 days was observed on the collagen-coated suture tape (64.0±24.9 cells/mm2), while the lowest was observed on silicone-coated (5.0±5.1 cells/mm2). The collagen-coated and both uncoated suture tapes similarly supported 3.6- to 4.2-fold cell proliferation over 14 days, significantly more than observed on the silicone-coated tape (2.5±0.8-fold). The composition and coatings of suture tape may have biological consequences for ligament repair. Level of Evidence: Diagnostic in vitro study. See Instructions for Authors for a complete description of levels of evidence.

OC-037 Triclosan-coated sutures decrease the risk of surgical site infection in abdominal surgery. A systematic review and meta-analysis

Abstract Aim Surgical site infection (SSI) occurs in 2–10% of the patients after abdominal surgery and has an impact on morbidity, mortality and medical costs. The aim of this systematic review and meta-analysis was to evaluate whether the use of triclosan-coated sutures for fascial closure in adominal surgery decrease the rate of SSI compared to uncoated sutures. Methods A systematic review and meta-analysis was conducted using the PRISMA guidelines. A literature search was performed in Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Embase. The latest search was performed on January, 21th, 2023. Risk of bias was assessed using the Cochrane RoB 2 tool. A pooled meta-analysis was performed using RevMan. Results Out of 1356 records, ten Randomized Controlled Trials, with a total of 9432 patients were included: 4763 in the Triclosan-coated group and 4660 in the uncoated group. The overall SSI rate was significantly reduced in the Triclosan-coated group with an Odds Ratio (OR) of 0.84 (95% CI [0.76; 0.94] p = 0.002). If PDS was evaluated separately (PDS Plus = 3999, PDS = 3900), triclosan-coating reduced SSI with an OR of 0.86 (95% CI [0.77; 0.96], p = 0.008). When Vicryl was evaluated (Vicryl Plus = 764, Vicryl = 760), the OR was 0.71 (95% CI [0.48; 1.04], p = 0.08) and was not significant. Conclusions In this current meta-analysis, it was found that the incidence of SSIs decreases when triclosan-coated sutures are used for fascial closure, compared to the uncoated sutures group.

Use of monofilament sutures and triclosan coating to protect against surgical site infections in spinal surgery: a laboratory-based study

PurposeWe investigated bacterial propagation through multifilament, monofilament sutures and whether sutures coated with triclosan would exhibit a different phenomenon.MethodsOne centimetre (cm) wide trenches were cut in the middle of Columbia blood Agar plates. We tested a 6 cm length of two Triclosan-coated (PDS plus®, Vicryl plus®) and two uncoated (PDS ®, Vicryl ®) sutures. Each suture was inoculated with a bacterial suspension containing methicillin-sensitive Staphylococcus aureus (MSSA), Escherichia coli (E. coli), Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA) at one end of each suture. The plates were incubated at 36C for 48 h, followed by room temperature for a further 5 days. We established bacterial propagation by observing for any bacterial growth on the Agar on the opposite side of the trench.ResultsBacterial propagation was observed on the opposite side of the trench with both suture types, monofilament PDS and multifilament Vicryl, when tested with the motile bacterium (E. coli). Propagation was not observed on the other side of the trench with the monofilament PDS suture following incubation with MSSA and S. epidermidis, and in 66% of MRSA. With multifilament suture Vicryl, propagation was observed on the other side of the trench in 90% (MSSA), 80% (S. epidermidis), and 100% (MRSA) of plates tested. No bacterial propagation was observed in any of the triclosan-coated sutures (monofilament or multifilament).ConclusionsMonofilament sutures are associated in vitro with less bacterial propagation along their course when compared to multifilament sutures. Inhibition in both sutures can be further enhanced with a triclosan coating.

A comparative assessment of antibacterial properties of neem oil coated sutures: An in vitro study.

When it comes to surgical site infection (SSI), it has been shown that two-thirds of wound infections starts around the incision line and the number is even greater in the presence of sutures. Therefore, a number of compounds have been used to coat the suture materials which tend to decrease the SSI some of which include ciprofloxacin, Aloe vera, and chlorhexidine. The objective of this study was to assess the antibacterial properties of neem oil-coated sutures in anaerobic culture media when compared to triclosan-coated sutures and uncoated sutures. The phosphate-buffered saline solution containing the plaque samples of the patients was transferred evenly onto the sterile agar media. Equal segments of 100% neem oil coated (Group 1), 50% neem oil coated (Group 2), triclosan-coated (Group 3), and uncoated (Group 4) sutures were placed on the agar plate. These were then incubated at 37°C for 24 h. The inhibition zone was calculated in mm by measuring of the zone of inhibition (ZOI) in terms of length, breadth, and area. The results were calculated following the incubation. The mean length for 100% neem oil-coated suture was 2.61 mm ± 0.2 and for 50% neem oil-coated suture was 2.49 mm ± 0.24. The mean breadth for 100% neem oil-coated suture was 1.5 mm ± 0.41 and for 50% neem oil-coated suture the mean was 0.95 mm ± 0.58. The mean area for 100% neem oil-coated suture was 77 mm ± 32.9 and for 50% neem oil-coated suture was 16.8 mm ± 11.14. Triclosan and uncoated sutures did not show any ZOI. The 100% neem oil-coated sutures had the largest length, breadth, and area of ZOI in the anaerobic culture media, followed by 50% neem oil-coated sutures. Triclosan-coated and uncoated sutures did not show any ZOI. Therefore, neem oil-coated suture can be used in the overall healing and prevention of postoperative discomfort after oral surgical procedures.

Correction: Effectiveness of Triclosan-Coated Sutures Compared with Uncoated Sutures in Preventing Surgical Site Infection after Abdominal Wall Closure in Open/Laparoscopic Colorectal Surgery.

Journal of the American College of Surgeons 235(6):p 968-969, December 2022. | DOI: 10.1097/XCS.0000000000000388

Correction: Effectiveness of Triclosan-Coated Sutures Compared with Uncoated Sutures in Preventing Surgical Site Infection after Abdominal Wall Closure in Open/Laparoscopic Colorectal Surgery.

Correction: Effectiveness of Triclosan-Coated Sutures Compared with Uncoated Sutures in Preventing Surgical Site Infection after Abdominal Wall Closure in Open/Laparoscopic Colorectal Surgery.

Alcoholic chlorhexidine skin preparation or triclosan-coated sutures to reduce surgical site infection: a systematic review and meta-analysis of high-quality randomised controlled trials

WHO and the UK's National Institute for Health and Care Excellence recommend alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent surgical site infections (SSIs). Existing meta-analyses that include studies at high risk of bias, combined with the recent publication of large, randomised trials, justify an updated meta-analysis of high-quality randomised controlled trials (RCTs). We aimed to test the rates of SSI according to skin preparation solutions (ie, alcoholic chlorhexidine vs aqueous povidone-iodine) and types of sutures (ie, coated vs uncoated). In this systematic review and meta-analysis, we searched MEDLINE, Embase, Pubmed, and Cochrane Library databases, with no language restrictions, to identify high-quality RCTs testing either alcoholic chlorhexidine skin preparation (vs aqueous povidone-iodine) or triclosan-coated sutures (vs uncoated sutures), or both, published from database inception to Sept 1, 2021. Patients who received clean-contaminated, contaminated, or dirty surgery were included. We predefined the characteristics of a high-quality trial through an expert consensus process to develop an enhanced Cochrane risk of bias-2 tool specifically for RCTs with a primary outcome of SSI. Data were extracted from published reports. Meta-analysis was performed using a random-effects model and heterogeneity was assessed using the I2 statistic. This systematic review and meta-analysis was prospectively registered in PROSPERO, CRD42021267220. Of 942 studies identified, 933 were excluded. Four high-quality RCTs (n=7467 patients) were included that tested alcoholic chlorhexidine. No significant difference in SSI rates was noted between alcoholic chlorhexidine and aqueous povidone-iodine (17·9% [667 of 3723 patients] vs 19·8% [740 of 3744 patients]; odds ratio 0·84 [95% CI 0·65-1·06]; p=0·21, I2=53·1%). Five high-quality RCTs were included that tested triclosan-coated sutures (n=8619 patients), with no significant difference noted between triclosan-coated and uncoated sutures (16·8% [733 of 4360 patients] vs 18·4% [784 of 4259 patients]; OR 0·90 [95% CI 0·74-1·09]; p=0·29, I2=36·4%). Contrary to previous meta-analyses, this study did not show a benefit from either alcoholic chlorhexidine skin preparation or triclosan-coated sutures, both of which are more expensive than other readily available alternatives. Global and national guidance should be reconsidered to remove recommendations for their routine use. National Institute for Health Research (NIHR) Global Health Research Unit.

Effectiveness of Triclosan-Coated Sutures Compared with Uncoated Sutures in Preventing Surgical Site Infection after Abdominal Wall Closure in Open/Laparoscopic Colorectal Surgery.

Previous randomized trials have assessed the effectiveness of triclosan-coated sutures in fascia closure after midline laparotomy in preventing surgical site infections (SSIs); however, available evidence remain inconclusive. We aimed to evaluate the effectiveness of triclosan-coated sutures in abdominal fascia closure to prevent postoperative SSIs. This study was a multicenter prospective trial conducted within 24 Japanese secondary and tertiary care centers and a propensity score (PS)-matched analysis. Patients 20 years of age or older who underwent elective surgery for colorectal cancer (CRC) were included. Between July 2016 and July 2019, 2,207 patients were prospectively enrolled into the triclosan-coated sutures or uncoated sutures groups. The per-protocol population comprised 2,195 patients. The PS matching was performed for 1,579 patients: 926 patients in the coated group and 653 patients in the uncoated group. The abdominal fascia after midline laparotomy was closed with triclosan-coated or uncoated sutures depending on group. The primary endpoint was the incidence of an SSI. Secondary endpoints were length of hospital stay and surgical complication rates. The recorded SSI rates were 4.2% in the triclosan-coated group and 6.74% in the uncoated suture group (p = 0.028). There were no serious adverse events in the groups. The final logistic regression model showed that several variables affected the occurrence of SSI. Our meta-analysis included six phase-III trials, and our study evaluated 4,797 patients. The results show a significant superiority of triclosan-coated sutures over uncoated suture material. Triclosan-coated sutures reduce the incidence of SSI after elective CRC surgery.

PLGA Nanoparticle Rapamycin- or Necrostatin-1-Coated Sutures Inhibit Inflammatory Reactions after Arterial Closure in Rats.

Background: The inflammatory reaction of sutures and oozing after arterial closure depends on the suture material and the amount of oozing surrounding the sutures. Anti-inflammation coatings have been proven to be an effective strategy to decrease this reaction. The aim of this study was to establish an arterial closure oozing model in rats and to test the effect of poly (lactic-co-glycolic acid) (PLGA) nanoparticle (NP) rapamycin- or necrostatin-1(NEC-1)-coated sutures on the inflammatory reaction after arterial closure. Methods and Materials: A 10 mm arteriotomy was carried out on the carotid artery of Sprague-Dawley rats and closed using 11-0 sutures. PLGA NP-rapamycin and NEC-1 were made. The 11/0 nylon sutures were coated with PLGA NP-rapamycin and NEC-1. Sutures were examined by scanning electron microscopy, hemolysis test, and cumulative release. The carotid arteriotomy was closed using uncoated PLGA NP-rapamycin- and NP-NEC-1-coated sutures. The carotid artery was harvested on day 7. Tissues were examined by histology and immunohistochemistry. Results: There were severe inflammatory reactions in the oozing arteries compared to the normal healing arteries (P = 0.0192). PLGA NP-rapamycin- and NEC -1-coated sutures reduced foreign body reaction compared to the uncoated sutures. There were significantly smaller number of CD3 (P = 0.0068), CD45 (P = 0.0300), and CD68 (P = 0.0011) cells in the PLGA NP-rapamycin- and NP-NEC-1-coated groups compared to the uncoated group. There was a smaller number of p-mTOR (P = 0.0198)-positive cells in the PLGA NP-rapamycin-coated group compared to the uncoated group. There was a smaller number of TNFα (P = 0.0198)-positive cells in the PLGA NP-NEC-1-coated group compared to the uncoated group. Conclusions: In this rat carotid artery oozing model, PLGA NP-rapamycin- or NP-NEC-1-coated sutures can inhibit inflammatory reaction and foreign body reaction. Although this was a small rodent animal experiment, this coated suture may have a potential clinical application in the future.

Engineering surgical stitches to prevent bacterial infection

Surgical site infections (SSIs) account for a massive economic, physiological, and psychological burden on patients and health care providers. Sutures provide a surface to which bacteria can adhere, proliferate, and promote SSIs. Current methods for fighting SSIs involve the use of sutures coated with common antibiotics (triclosan). Unfortunately, these antibiotics have been rendered ineffective due to the increasing rate of antibiotic resistance. A promising new avenue involves the use of metallic nanoparticles (MNPs). MNPs exhibit low cytotoxicity and a strong propensity for killing bacteria while evading the typical antibiotic resistance mechanisms. In this work, we developed a novel MNPs dip-coating method for PDS-II sutures and explored the capabilities of a variety of MNPs in killing bacteria while retaining the cytocompatibility. Our findings indicated that our technique provided a homogeneous coating for PDS-II sutures, maintaining the strength, structural integrity, and degradability. The MNP coatings possess strong in vitro antibacterial properties against P aeruginosa and S. aureus—varying the %of dead bacteria from ~ 40% (for MgO NPs) to ~ 90% (for Fe2O3) compared to ~ 15% for uncoated PDS-II suture, after 7 days. All sutures demonstrated minimal cytotoxicity (cell viability > 70%) reinforcing the movement towards the use MNPs as a viable antibacterial technology.

Biologically Augmented Suture for Ligament Bracing Procedures Positively Affects Human Ligamentocytes and Osteoblasts In Vitro

The purpose was to evaluate the response of human ligamentocytes and osteoblasts after biological augmentation with thrombin, concentrated bone marrow aspirate (cBMA), or platelet-rich plasma (PRP) on two different types of nonresorbable flat braided suture used for ligament bracing. Uncoated (U) and collagen-coated (C) flat braided suture material was augmented with either thrombin (T), cBMA (B), PRP (P), or a combination of these three (A), while platelet-poor plasma was used as a source for fibrin (F) in each assay. Previously cultured ligamentocytes and osteoblasts were added with a defined density and assayed after the required time period for adhesion, proliferation, and alkaline phosphatase activity. Biological augmentation of uncoated [(UFT, UFBT, UFA; P < .001), (UFPT; P= .017)] and collagen-coated suture (CFT, CFPT, CFBT, CFA; P < .001) led to a significantly higher ligamentocyte adhesion. Significantly higher adhesion was also observed for osteoblasts (UFT, UFPT, UFBT, UFA; P < .001; CFT, CFPT, CFBT, CFA; P < .001). Similarly, ligamentocyte proliferation was significantly higher [(UFT, UFPT, UFA; P= .009), (UFBT; P= .001), (CFT; P=.009), (CFBT; P= .001), and (CFA; P= .01)]. Osteoblasts showed significantly higher proliferation as well [(UFT, UFPT,UFA; P= .002), (UFBT; P= .001); (CFT: P= .003), and (CFPT, CFBT, CFA; P= .001)]. Augmentation with thrombin, PRP, and BMA for uncoated (UFT; P= .006, UFPT; P= .035, UFBT; P= .001) and BMA for coated suture (CFBT; P= .027) led to significantly higher alkaline phosphatase activity. Biological enhancement of suture used for ligament bracing significantly increased ligamentocyte and osteoblast adhesion and proliferation, as well as alkaline phosphatase activity of osteoblasts in an invitro model. After biological augmentation, cellular adhesion, proliferation, and alkaline phosphatase activity changed up to 1,077%, 190%, and 78%, respectively. Furthermore, no overall superiority between uncoated or collagen-coated suture material was observed for cellular adhesion, proliferation, or alkaline phosphatase activity. This study provides invitro data on a new treatment concept of biologic augmentation for acute ligamentous lesions treated with ligament bracing that has not been widely described. This concept may improve the healing of injured ligaments, in addition to providing immediate biomechanical stabilization.

Antibacterial functionalization of nylon monofilament surgical sutures through in situ deposition of biogenic silver nanoparticles

Antibacterial coating of nylon monofilament sutures presents difficulties unlike non-absorbable braided sutures due to the nature of nylon material and absence of interstices. To solve these problems, a new technique using in situ deposition of biogenic silver nanoparticles (AgNPs) has been developed to coat nylon surgical sutures. The effect of AgNPs deposition on the surface roughness was observed, with significant reduction in average roughness (9.41 ± 0.96 nm), compared with uncoated sutures (12.35 ± 0.20 nm) (P < 0.05). The ICP-OES analysis of coated sutures revealed total Ag+ concentration of 11.25 ± 0.14 μg/mL, with an AgNPs release of 11.25, 11.27, 19.94, and 24.03% at 1, 3, 5, and 7 days, respectively. The sutures demonstrated bactericidal effects on Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae) wound pathogens with more than 99.9% reduction. The coated sutures indicated stable antibacterial activity against representative Gram-positive and Gram-negative isolates after 12-week storage. Haemolytic evaluation of coated sutures showed less than 1% lysis of human erythrocytes. In addition, coated sutures inhibited lipopolysaccharide-induced nitric oxide generation by 15.46 μM reduction. Cytocompatibility test on L929 fibroblast cells revealed approximately 81% cell viability and promoted cell migration by 51% after 24 h treatment. The study revealed that in situ deposition of AgNPs on nylon monofilament sutures did not alter the mechanical properties of the sutures, but conferred antibacterial and wound healing properties.

Development of Environmentally Safe Biodegradable, Antibacterial Surgical Sutures Using Nanosilver Particles

Bacterial infection from medical devices is a significant problem and accounts for an increasing number of deaths and high medical costs. Surgical sutures are a major source of nosocomial infection through surgical wound contamination and the rates of which are increasing globally. One efficient way to prevent this is by modifying the surface of the sutures in such a way that no bacterial adhesion can occur. In this investigation, biodegradable polymer sutures with excellent antibacterial properties were developed. Antibacterial properties were achieved by coating nanosilver incorporated biopolymer polycaprolactone material on the surface of the sutures. Biocompatible polyethylene glycol was selected as the solvent for the dispersion of nanosilver particles, which improved the mechanical properties of the sutures. The nanoparticle coating was found to be uniform and more effective with the electrospinning method. The mechanical property of the coated suture was analysed using the Universal Test Method, and the results were in agreement with the standard results. The surface morphology of coated sutures becomes uniform on adding nanosilver particles, confirmed by scanning electron microscope studies. A comparative study of force–displacement, hardness, and reduced modulus as a function of contact depth indentation tests were performed on coated and uncoated suture samples using a Nanoindentation Test Machine. In-situ Scanning Probe Microscopy images were captured for coated and uncoated suture materials. These studies confirmed a new strategy in developing antibacterial sutures suitable for wound closure following surgery.

Meta-Analysis of High Quality Randomised Controlled Trials Testing Alcoholic Chlorhexidine Skin Preparation or Triclosan Coated Sutures to Reduce Surgical Site Infection

Background: The World Health Organisation and the UK’s National Institute of Clinical Excellence recommend alcoholic chlorhexidine skin preparation and triclosan coated sutures to prevent surgical site infections (SSI). Existing meta-analyses that include high risk of bias studies combined with recent publication of large randomised trials together justify an updated meta-analysis of high quality randomised controlled trials (RCTs). Methods: A systematic review was performed to identify high quality RCTs testing either alcoholic chlorhexidine skin preparation (versus aqueous povidone-iodine) and/or triclosan coated sutures (versus uncoated sutures), until September 2021. Patients undergoing clean-contaminated, contaminated, or dirty surgery were included. We pre-defined the characteristics of a high quality trial through an expert consensus process that modified the Cochrane Risk of Bias tool specifically for RCTs with a primary outcome of SSI. Findings: Four high quality RCTs (n=7,467 patients) were included that tested alcoholic chlorhexidine. There was no significant difference in SSI rates between alcoholic chlorhexidine and aqueous povidone-iodine (17.9% vs 19.8%, OR 0.84, 95% CI 0.65-1.06, p=0.205). Five high quality RCTs were included that tested triclosan coated sutures (n=8,619 patients), with no significant difference between coated and uncoated sutures (16.7% vs 18.5%, OR 0.81, 95% CI 0.65-1.08, p=0.177). Stratified analyses demonstrated consistent results for clean-contaminated surgery, but only one trial was included that addressed contaminated/dirty surgery for either interventions. Interpretation: Contrary to previous meta-analyses, this study did not show benefit from either alcoholic chlorhexidine skin preparation or triclosan coated sutures, both of which are more expensive than other readily available alternatives. Global and national guidance should be reconsidered to remove strong recommendations for their routine use. Funding Information: National Institute for Health Research (NIHR) Global Health Research Unit. Declaration of Interests: The authors have no conflicts of interest to declare.

Chlorhexidine Coated Polyglactin Sutures In Prevention Of Surgical Site Infection

Surgical Site Infections (SSIs) are one of the most common complications of any intervention in the maxillofacial region. Most of the times sutures used for wound approximation act as a nidus of bacterial accumulation and subsequent infection due to the presence of scores of microbes in and around the oral cavity. This has been attributed to the wicking action associated with braided sutures. Various methods to prevent surgical site infections are reported in literature, the most recent being use of antibacterial coated sutures. Sutures are either coated with triclosan or chlorhexidine or a combination of anti-microbial agents and fatty acids. These sutures are known to have a significant role in the prevention of SSIs elsewhere in the body, but the role in oral cavity remains questionable. This study aims to establish the role of chlorhexidine coated sutures in the prevention of surgical site infections if any. Chlorhexidine-coated and uncoated suture materials were used in 17 patients undergoing third molar extractions. Seven days post-operatively the sutures were removed, and bacteria were isolated. Following which colony-forming units (CFU/ml) were counted. Concerning the total number of oral pathogens, that adhered to suture material, no reduction was demonstrated for Chlorhexidine coated sutures. The use of chlorhexidine-coated suture material offers no advantage in intraoral surgery.

Antibacterial-coated silk surgical sutures by ex situ deposition of silver nanoparticles synthesized with Eucalyptus camaldulensis eradicates infections

Surgical site infection arising from microbial contamination of surgical wounds is a major cause of surgical complications and prolong hospital stay. In this study, silver nanoparticles (AgNPs) biosynthesized using Eucalyptus camaldulensis extract were deposited on silk surgical sutures by ex situ method. Adherence of AgNPs to the surface of sutures was observed, with significantly reduced surface roughness (323.7 ± 16.64 nm), compared with uncoated sutures (469.3 ± 7.31 nm) (P < .001). Elasticity of AgNPs-coated (13 ± 1.485%) and uncoated (8 ± 0.728%) sutures was also significantly different (P < .05). Quantification of AgNPs demonstrated release of 3.88, 5.33, 5.44, 6.14% on day 1, 3, 5, 7, respectively from total Ag+ concentration (6.14 ± 0.14 μg/mL). The coated sutures produced a strong bacteriostatic effect on Staphylococcus aureus, an important wound pathogen with approximately 99% reduction in growth. In contrast, bactericidal effects were observed with Gram-negative pathogens including Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Cytocompatibility tested on human keratinocyte cells exhibited approximately 80% cell viability. The coated sutures revealed stable antibacterial properties up to 12 weeks. This work suggested the potency of AgNPs-coated sutures as a suitable biocompatible medical device for the management of surgical site infections.