Use Of Triclosan-coated Sutures Research Articles

Systematic review and meta-analysis comparing surgical site infection in abdominal surgery between triclosan-coated and uncoated sutures.

Surgical site infection (SSI) is a frequent complication after abdominal surgery and impacts morbidity, mortality and medical costs. This systematic review evaluates whether the use of triclosan-coated sutures for closing the fascia during abdominal surgery reduces the rate of SSI compared to uncoated sutures. A systematic review and meta-analysis were conducted using the PRISMA guidelines. On February 17, 2024, a literature search was performed in Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Embase. Randomized controlled trials (RCTs) on abdominal fascial closure in human adults, comparing triclosan-coated and uncoated sutures, were included. The risk of bias was assessed using the Cochrane RoB 2 tool. Pooled meta-analysis was performed using RevMan. Out of 1523 records, eleven RCTs were included, with a total of 10,234 patients: 5159 in the triclosan-coated group and 5075 in the uncoated group. The incidence of SSI was statistically significantly lower in the triclosan-coated group (14.8% vs. 17.3%) with an odds ratio (OR) of 0.84 (95% CI [0.75, 0.93], p = 0.001). When polydioxanone was evaluated separately (coated N = 3999, uncoated N = 3900), triclosan-coating reduced SSI; 17.5% vs. 20.1%, OR 0.86 (95% CI [0.77; 0.96], p = 0.008). When polyglactin 910 was evaluated (coated N = 1160, uncoated N = 1175), triclosan-coating reduced the incidence of SSI; 5.4% vs. 7.8%, OR 0.67 (95% CI [0.48; 0.94], p = 0.02). According to the results of this meta-analysis the use of triclosan-coated sutures for fascial closure statistically significantly reduces the incidence of SSI after abdominal surgery with a risk difference of about 2%.

International Delphi Study on Wound Closure and Incision Management in Joint Arthroplasty Part 2: Total Hip Arthroplasty

BackgroundThis modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures. MethodsAn international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty). There were 3 rounds of anonymous voting per topic using a modified 5-point Likert scale with a predetermined consensus threshold of ≥ 75% agreement necessary for a statement to be accepted. ResultsAfter 3 rounds of voting, consensus was achieved for all 18 statements. Notable recommendations for THA wound management included (1) the use of barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); (2) the use of subcuticular sutures over skin staples (lower risk of superficial infections and higher patient preferences, but longer closing times); (3) the use of mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); (4) for at-risk patients, the use of negative pressure wound therapy over other dressings (lower wound complications and reoperations, as well as fewer dressing changes); and (5) the use of triclosan-coated sutures (lower risk of surgical site infection) over standard sutures. ConclusionsThrough a structured modified Delphi approach, a panel of 20 orthopedic surgeons reached consensus on all 18 statements pertaining to wound closure and incision management in THA. This study provides a foundational framework for establishing evidence-based best practices, aiming to reduce variability in patient outcomes and to enhance the overall quality of care in THA procedures.

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.

Effect of triclosan-coated sutures for abdominal wound closure on the incidence of abdominal wound dehiscence: a protocol for an individual participant data meta-analysis

IntroductionAcute abdominal wound dehiscence (AWD) or burst abdomen is a severe complication after abdominal surgery with an incidence up to 3.8%. Surgical site infection (SSI) is the biggest risk factor...

An economic model to assess the value of triclosan-coated sutures in reducing the risk of surgical site infection in orthopedic surgeries in India

Background: The incidence of surgical site infections is higher in India compared to the rest of the world. In orthopedic surgeries, the risk is even higher. Surgical site infections following orthopedics are associated with an additional length of stay resulting in additional costs thus causing a significant economic burden on patients and society.We aimed to determine the additional costs and length of stay and evaluate the efficacy of triclosan-coated sutures in reducing surgical site infections rate. Materials and Methods: A systematic literature search of available evidence for both epidemiologic and economic data pertaining to the incidence of surgical site infections and efficacy of triclosan-coated sutures, from 1998-2018 and 2000-2018 respectively, were gathered. We compared 100 surgeries from private and public hospitals from orthopedics and calculated cost-effectiveness of triclosan-coated sutures in comparison to conventional non-coated sutures using a decision-tree cost model. Results: Two studies were analysed for analysis of surgical site infections’ incidence and for the efficacy of triclosan-coated sutures vs non-coated sutures, 3 studies were included.We performed a one-way sensitivity analysis to calculate the impact of % efficacy and surgical site infections’ incidences %, cost of noncoated and triclosan-coated sutures on cost savings depicted by Tornado charts. Sensitivity analysis on the comparison of triclosan-coated sutures with non-coated sutures, a base cost saving of orthopedic surgeries for a private hospital was is INR -5573 and public hospital INR -1410. Conclusion: The use of triclosan-coated sutures reduced surgical site infections incidence and cost savings for orthopedic surgeries in both public and private sectors in India. Keywords: Orthopedic, Non-coated suture, Surgical site infection, Triclosan-coated suture.

Incisional Surgical Site Infection after Abdominal Fascial Closure with Triclosan-Coated Barbed Suture vs Triclosan-Coated Polydioxanone Loop Suture vs Polydioxanone Loop Suture in Emergent Abdominal Surgery: A Randomized Clinical Trial

Triclosan-coated sutures have been shown to reduce surgical-site infection (SSI) in emergent operation for fecal peritonitis. Barbed sutures provoke a homogeneous distribution of tension throughout the suture, implying better blood supply to the wound edges and healing. The aim of this study was to evaluate the effect, on SSI and evisceration, of using triclosan-coated and barbed sutures for fascial closure in patients undergoing emergent surgery. A prospective, randomized clinical trial was performed. Patients were randomized into 3groups: those undergoing aponeurotic closure with triclosan-coated barbed suture (Stratafix Symmetric [Johnson & Johnson]), patients undergoing closure with triclosan-coated polydioxanone loop suture (PDS plus [Johnson & Johnson]), and patients undergoing closure with polydioxanone loop suture (PDS [Johnson & Johnson]). Primary investigated outcomes were SSI and evisceration rates during a follow-up period of 30 days. The primary analysis plan was based on a per-protocol approach. Incisional SSI was 6.4% (3 of 47) in the Stratafix Symmetric group, 8.9% (4 of 45) in the PDS plus group, and 23.4% (11 of 47) in PDS group (p= 0.03). The evisceration rate was 0% in Stratafix Symmetric, 8.9% (4 of 45) in PDS plus, and 12.8% (6 of 47) in PDS (p= 0.05). Median hospital stay was 4 days (range 2 to 14 days) in Stratafix Symmetric, 5 days (range 2 to 21 days) in PDS plus, and 8 days (range 2 to 60 days) in PDS (p= 0.012). The use of triclosan-coated sutures (Stratafix Symmetric and PDS plus) was associated with a lower risk of incisional SSI (p= 0.009), and the use of barbed suture was associated with a lower risk of evisceration (p= 0.019). Comparing Stratafix Symmetric with PDS plus, there were no significant differences in SSIs, but the evisceration rate was significantly higher in the PDS plus group (p= 0.036). The use of triclosan-coated sutures (Stratafix Symmetric and PDS plus) in emergent surgery reduces the incidence of incisional SSIs. The use of barbed sutures reduces the incidence of evisceration.

The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature

Introduction and objectivesSurgical site infections (SSIs) represent a common and serious complication of all surgical interventions. Microorganisms are able to colonise sutures that are implanted in the skin, which is...

An Incision Closure Bundle for Colorectal Surgery: 2.0 www.aornjournal.org/content/cme.

Surgical site infections (SSIs) are among the most common and expensive of all health care–associated infections, and as many as 50% are considered preventable. Surgical care bundles, which involve a small set of reliably performed evidence-based practices, may effectively reduce SSI rates. However, closure of the surgical incision is one aspect of surgical care that is not well described in current SSI prevention bundles; this presents an opportunity for perioperative professionals to improve care by identifying and implementing evidence-based incision closure practices for high-risk procedures (eg, colorectal surgery). We propose and review the evidence supporting a colorectal incision closure bundle composed of a glove and sterile instrument set change, irrigation with 0.05% chlorhexidine solution, use of triclosan-coated sutures, removal of surgical drapes after applying postoperative dressings, use of topical skin adhesive or an antiseptic dressing, and distribution of comprehensive postoperative patient instructions.

The effect of triclosan-coated sutures on the rate of surgical site infection after hip and knee arthroplasty: a double-blind randomized controlled trial of 2546 patients.

AimsSurgical site infection (SSI) is a common complication of surgery with an incidence of about 1% in the United Kingdom. Sutures can lead to the development of a SSI, as micro-organisms can colonize the suture as it is implanted. Triclosan-coated sutures, being antimicrobical, were developed to reduce the rate of SSI. Our aim was to assess whether triclosan-coated sutures cause a reduction in SSIs following arthroplasty of the hip and knee.Patients and MethodsThis two-arm, parallel, double-blinded study involved 2546 patients undergoing elective total hip (THA) and total knee arthroplasty (TKA) at three hospitals. A total of 1323 were quasi-randomized to a standard suture group, and 1223 being quasi-randomized to the triclosan-coated suture group. The primary endpoint was the rate of SSI at 30 days postoperatively.ResultsThe baseline characteristics of age, gender and comorbidities were well matched in the two groups. The rates of superficial SSI were 0.8% in the control group and 0.7% in the intervention group (p = 0.651), and when deep and superficial SSIs were combined the rates were 2.5% and 1.8 (p = 0.266). The length of stay in hospital and the rates of medical complications did not differ significantly between the groups (p = 1.000).ConclusionThis trial provided no evidence that the use of triclosan-coated sutures at THA and TKA leads to a reduction in the rate of SSI.Cite this article: Bone Joint J 2018;100-B:296–302.

Effect of the Abdominal Fascial Closure with Triclosan-Coated Sutures in Fecal Peritonitis, on Surgical Site Infection, and Evisceration: A Retrospective Multi-Center Study.

Surgical site infection (SSI) is a frequent complication in dirty surgery, reaching rates of up to 40%. The incidence of SSI might be influenced by the suture used for closure of the abdominal fascia. Sutures coated with antibacterial substances may reduce the bacterial load in the incision. A retrospective study of patients with intra-operative diagnosis of fecal peritonitis undergoing a laparotomy in three Spanish hospitals was performed. Fascial closure consisted in running loop suture of Polyglactin (Vicryl loop®, Johnson & Johnson, New Brunswick, NY; group 1), running loop suture of triclosan-coated polyglactin (Vicryl plus loop®; group 2), running loop suture of polydioxanone (PDS loop® Johnson & Johnson; group 3), and running loop suture of triclosan-coated polydioxanone (PDS plus loop®; group 4). Incisional SSI and evisceration rates were assessed. One hundred four patients were included. There were no differences in age, gender, comorbidities, etiology of peritonitis, and mortality among groups. Surgical site infection rate was 34.6% in group 1; 8% in group 2; 33% in group 3; and 10% in group 4 (p = 0.029). The use of triclosan-coated sutures is associated with lower risk of SSI (risk ratio [RR]: 9; p = 0.003). Evisceration rate was 0% in groups 1 and 2; 15.2% in group 3; and 10% in group 4 (p = 0.05). All patients suffering from evisceration presented previous SSI. The use of monofilament sutures is associated with higher risk of evisceration (RR: 6.35; p = 0.033). Triclosan-coated sutures reduce SSI rate in fecal peritonitis, without differences between braided and monofilament type. The use of monofilament sutures is related to higher risk of evisceration, independent of a triclosan coating.

A novel technique for chest drain removal using a two layer method with triclosan-coated sutures.

In thoracic surgery, a thoracic drain is always inserted after the surgical procedure. Repair of the wound after removal of the thoracic tube is performed postoperatively, but no universally standard methods currently exists for this tube removal. Here we report a technique using triclosan-coated sutures that is used in thoracic surgery in our hospital. There are several advantages of this technique. First, there is no need for stitches removal on follow-up. Second, it prevents the leakage of pleural exudate because of the tight two-layer sutures. In addition, it was observed to be superior in terms of both wound healing and cosmetic aspects, due to the layer-to-layer sutures. The use of triclosan-coated sutures helps prevent infection and empyema is quite unlikely to occur as the result of the tight ligating of the muscular layer using these sutures. We applied this method in 168 patients over a period of 24 months. There were no complications on removal of the chest tube such as infection, fluid leakage or opening of the surgical wound.

Triclosan sutures for surgical site infection in colorectal cancer

BackgroundAmong all procedures, surgical site infections (SSIs) in colorectal surgery continue to have the highest rate, accounting for 5%-45%. To prevent the bacterial colonization of suture material, which disables local mechanisms of wound decontamination, triclosan-coated sutures were developed. We assessed the effectiveness of triclosan-coated sutures used for skin closure on the rate of SSIs in colorectal cancer surgery. MethodsUntil August 2012, we used conventional methods for skin closure in colorectal cancer surgery at the Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine. Therefore, for the control group, we retrospectively collected surveillance data over a 1.5-y period. From September 2012, we began using triclosan-coated polydioxanone antimicrobial sutures (PDS plus) for skin and fascia closure. Hence, we collected data for the study group from September 2012 to October 2013. Differences in baseline characteristics and selection bias were adjusted using the propensity score-matching method. ResultsA total of 399 patients who underwent colorectal surgery were included in this study. There were 214 patients in the control group and 185 patients in the study group. Baseline patient characteristics were similar between the propensity score-matched groups. The incidence of SSIs was less in the study group. Multivariate logistic regression analysis showed that the site of the procedure, laparoscopic surgery, and using triclosan-coated sutures remained the independent predictors of SSIs. ConclusionsThe use of triclosan-coated sutures was advantageous for decreasing the risk of SSIs after colorectal surgery.

Association between Triclosan-Coated Sutures for Abdominal Wall Closure and Incisional Surgical Site Infection after Open Surgery in Patients Presenting with Fecal Peritonitis: A Randomized Clinical Trial.

A factor that may influence the incidence of surgical site infections (SSIs) is the suture used for closure of the abdominal wall because bacteria may adhere to the suture material. Sutures can be coated with antibacterial substances that may reduce the bacterial load in the incision. The aim of this study was to evaluate the effect of triclosan-coated sutures used in abdominal wall closure in patients with fecal peritonitis. A randomized study was performed. Inclusion criteria were intra-operative diagnosis of fecal peritonitis secondary to acute diverticulitis perforation, neoplastic tumor perforation, or colorectal anastomotic leak of previous elective colorectal resection. The patients were randomly assigned to either abdominal wall closure with triclosan-coated sutures (group 1) or sutures without triclosan (group 2). Fifty patients were included in group 1 and 51 in group 2. The incisional SSI rate was 10% in group 1 and 35.3% in group 2 (p=0.004; odds ratio [OR]=0.204; 95% confidence interval [CI] 0.069-0.605). A significant reduction in SSIs caused by Escherichia coli and Enterococcus faecalis was observed in group 2. The use of triclosan-coated sutures in fecal peritonitis surgery reduces the incidence of incisional SSI.

Triclosan-coated abdominal closure sutures reduce the incidence of surgical site infections after pancreaticoduodenectomy.

Surgical site infection (SSI) is a serious complication after pancreaticoduodenectomy (PD). To prevent microbial colonization of suture material in operative wounds, triclosan-coated polyglactin sutures with antibacterial activity have been developed recently. Several clinical studies have shown that the use of such suture reduces SSIs in various operations, but its efficacy in PD has not been studied. We evaluated whether the incidence of SSI can be reduced when triclosan-coated sutures are used for abdominal incision closure after PD. This controlled clinical trial took place between December 2005 and February 2012 with a total of 198 consecutive patients who had undergone PD. The study group received triclosan-coated polyglactin 910 antimicrobial sutures between March 2009 and February 2012, and the control group received conventional wound closure between January 2005 and February 2009. We compared the rate and types of infections in the two groups. In the study group, age, the incidence of diabetes mellitus, smoking history, and operating time were significantly greater than in the control group. The rates of SSI were 4.5% in the study group and 14.5% in the control group (p=0.037). The use of triclosan-coated sutures may help reduce the incidence of SSI after PD compared with conventional non-antibiotic sutures.

Effect of triclosan-coated sutures on surgical site infection after gastric cancer surgery via midline laparotomy.

PurposeSurgical site infection (SSI) after open abdominal surgery is still a frequently reported nosocomial infection. To reduce the incidence of SSI, triclosan-coated sutures with antiseptic activity (Vicryl Plus) were developed. The aim of this study was to analyze the effect of Vicryl Plus on SSI after gastric cancer surgery via midline laparotomy.MethodsA total of 916 patients who underwent gastric cancer surgery at Samsung Medical Center between December 2009 and September 2011 were prospectively collected. We examined the occurrence of SSI (primary endpoint), assessments of wound healing (secondary endpoint). They were evaluated postoperatively on days 3, 7, and 30.ResultsOf the 916 patients, 122 were excluded postoperatively by screening (out of the study protocol, adverse events, etc.). The remaining 794 patients were enrolled and monitored postoperatively. The cumulative SSI incidence was 11 cases (1.39%; 95% confidence interval [CI], 0.77-2.50) on day 30. Seromas were most frequently detected in wound healing assessments, with a cumulative incidence of 147 cases (18.51%; 95% CI, 15.98-21.39) on day 30.ConclusionThe use of triclosan-coated sutures (Vicryl Plus) for abdominal wall closure can reduce the number of SSIs in gastric cancer surgery.

Does the use of triclosan-coated sutures really reduce surgical site infection after open vein bypass grafting patients?

We read with interest Thimour-Bergstrom et al.’s recent article [1] on the randomized trial evaluating the effect of triclosan-coated sutures on the rate of surgical site infection (SSI) after open vein bypass grafting procedures. The authors’ report that leg-wound closure with triclosan-coated sutures reduces the SSI rate in coronary artery bypass surgery (CABG) patients after open vein harvesting. The study was double-blinded. The antibiotic prophylaxis and surgical wound methods were standardized. All wounds were inspected by a specially trained research nurse at 4 and 30 days after surgery and evaluated according to the Centre for Disease Control (CDC) definition of SSI [2]. On the 60th postoperative day the patients were interviewed by telephone and, if a patient reported any type of wound-healing problems, they were seen at the outpatient clinic. The incidence of SSI on the 30th and the 60th postoperative days was 9 and 12.5% in the triclosan-coated suture group and 13 and 20% in the control group, respectively. Their study has some limitations that make us unable to agree with the conclusion that triclosan-coated sutures reduce the risk of SSI after vein harvesting in CABG patients. First, the diagnosis of SSI according to the CDC definition should be made within 30 days of surgery. In this study, the difference in the incidence of SSI on the 30th postoperative day was only 4%. However, Thimour-Bergstrom et al. reported the diagnoses that were made on the 60th postoperative day. Furthermore, the primary diagnosis of SSI on the 60th postoperative day was made by a patient, not by a surgeon. Secondly, the authors reported the result of univariate analysis only. The number of bypasses was 3.0 in the triclosan group and 3.2 in the control group, P = 0.008. Furthermore, the number of bypasses was 3.4 among patients who developed leg infection and 3.1 among patients who did not develop leg infection P = 0.014. It is possible that the number of bypasses (because of the longer graft and operation time required) would have been an independent risk factor for infection rather than use of nontriclosan suture if the multivariate analysis were performed. Thirdly, the study was financially supported by Ethicon, Inc., Somerville, NJ, USA, the company providing triclosan-coated sutures. Thimour-Bergstrom et al. have conducted a finely designed study. However, the results of the 30th postoperative day should have been reported and a multivariate analysis of risk factors should have been performed. Appropriate analysis might have led to a conclusion that the use of triclosan-coated sutures does not reduce the risk of wound infection rate in CABG patients after open vein harvesting.

Effect of Triclosan‐Coated Sutures on the Incidence of Surgical Wound Infection After Lower Limb Revascularization Surgery: A Randomized Controlled Trial

Surgical wound infection (SWI) is a common complication after peripheral vascular surgery. In a prospective study, triclosan-coated sutures were reported to decrease the incidence of surgical site infection after various surgical procedures. The aim of our study was to test the hypothesis that use of triclosan-coated sutures decreases the incidence of SWI after lower limb vascular surgery. This prospective, randomized, multicenter, double-blinded trial was conducted between July 2010 and January 2011 in five hospitals in Finland. We randomly allocated 276 patients undergoing lower limb revascularization surgery to a study (n = 139) or a control (n = 137) group. Surgical wounds in the study group were closed with triclosan-coated suture material, and wounds in the control group were closed with noncoated sutures. The main outcome measure was SWI. A surgical wound complication was considered to be an infection if there were bacteria isolated from the wound or if there were areas of localized redness, heat, swelling, and pain around the wound appearing within 30 days after the operative procedure. Logistic regression analysis was used to assess the independent effect of triclosan-coated sutures on the incidence of SWI. Altogether, 61 (22.1 %) patients developed SWI. SWI occurred in 31 (22.3 %) patients in the study group and in 30 (21.9 %) patients in the control group (odds ratio 1.10, 95% confidence interval 0.61-2.01, p = 0.75.) The use of triclosan-coated sutures does not reduce the incidence of SWI after lower limb vascular surgery.