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PubMed2001

Suture materials and local recurrence in colorectal cancer: an experimental study.

OBJECTIVE: To investigate the carcinogenic role of suture materials in an experimental model in rats. DESIGN: Laboratory, experimental study. SETTING: University hospital, Spain. SUBJECTS: 125 Sprague-Dawley rats in 5 groups of 25 each. INTERVENTIONS: 3 Different suture materials (silk, polydioxanone, and titanium staples) were implanted in a region of the colon in 75 rats divided into three groups of 25. Another 25 animals were injured by puncture only in the same region, and a further 25 rats were not operated on (controls). Injections of 1-2,dimethylhydrazine were then given for 26 weeks. MAIN OUTCOME MEASURES: Number of rats in each group who had tumours in the region of interest, and level of infiltration of the tumours in each group. RESULTS: There were no differences between the injured and control rats in the number of tumours in the study zone. All groups in which suture material had been inserted had tumours in this zone. Titanium was more carcinogenic than either silk or polydioxanone. The tumours associated with titanium were the most infiltrating. CONCLUSIONS: We recommend the use of absorbable sutures, with a careful follow-up of patients in whom titanium staples have been used.

Animals↗
PubMed2003

The relationship between five kinds of laparoscopic knots and five types of suture materials and histological findings in tissues: an experimental study on rabbits.

The aim of the current study was to examine the slipping and the tightening of laparoscopic knots with various kinds of sutures, as well as the histologic alterations in tissues. Fifty rabbits and five kinds of sutures were used-silk, polyglactine-910 (Vicryl), Polydioxanone (PDS), Polyglycol (Dexon), and cat-gut chromic-and five laparoscopic knots were used-Tayside, Roeder, Melzer, Cross, and Blood. The knots were performed extracorporeally and were used to ligate a part of the omentum. Sliding and tightening of the knots were evaluated. The omentum, the suture, and the knots were checked 10 days and 1 month after operation. Histologic examination was performed 1 month after surgery. Polyglactine-910 (Vicryl) and silk were the most qualitative sutures used in Tayside, Roeder, and Blood knots and the least harmful for the tissues. Catgut chromic and Polydioxanone (PDS) were the most defective sutures. The most efficient laparoscopic slipknots are Tayside, Roeder, and Blood, especially when constructed with silk and polyglactine-910 (Vicryl).

Animals↗
PubMed1993

Intracutaneous butterfly suture with absorbable synthetic suture material. Technique, tissue reactions, and results.

BACKGROUND: Tension on surgical wound edges is often an obstacle to proper closure and good cosmetic results in dermatologic surgery. OBJECTIVE: A buried, butterfly-shaped, interrupted suture has been developed to remedy this. The suture is anchored very broadly in the corium, the knot is below the corium. The butterfly suture can be supplemented by a temporary running suture or by close-set, superficially placed interrupted sutures. METHODS: This technique was studied in a follow-up of 876 operations, with histologic study of 60 scars resulting from the suture. In particular, the specific advantages and disadvantages of two synthetic suture materials were compared: monofilament (polydioxanon) and polyfilament (polyglactin 910). RESULTS: Polydioxanon sutures were found to be clinically superior. It was important, however, that the suture knot be deeply anchored and that the surgeon be experienced. CONCLUSION: Cosmetic results of 18,000 procedures with this suture over a period of 6 years were found to be clearly better than those of surgery with conventional sutures.

Absorption↗
PubMedDate not supplied

Tissue reaction to suture material in the feline linea alba. A retrospective, prospective, and histologic study.

Swelling and inflammation along the incision line were observed after elective ovariohysterectomy in 22 of 66 cats in a retrospective study. In a prospective study of 99 feline abdominal incisions closed with surgical gut, polyglactin 910, or polydioxanone, with and without subcutaneous closure, the least inflammation occurred when the linea alba was sutured with polyglactin 910 and the subcutaneous tissues were not sutured. Histologically, reactions in the linea alba of 12 other cats progressed from purulent to fibromononuclear to fibrous within 14 days after closure with gut, polyglactin 910, and polydioxanone. Microscopic evidence of seroma formation in 9 of 12 animals in which the subcutaneous tissue was not sutured suggested that surgical closure of subcutaneous dead space was indicated. The inflammatory reaction did not appear to be related to any one suture material as reactions were seen with all of them.

Abdominal Muscles↗
PubMedDate not supplied

Mechanical properties of suture materials in vitro and after in vivo implantation in horses.

Tensile testing of reproducible loops of size 5 braided polyester, size 2 polyglycolic acid, size 2 monofilament nylon, and size 2 polydioxanone sutures was performed in vitro and after subcutaneous implantation in horses for 7, 14, and 28 days. Maximum breaking strength, energy absorption, and percentage elongation to breakage point were measured. Size 5 braided polyester had the highest maximum breaking strength and energy absorption over 28 days. Polydioxanone had better mechanical performance over 28 days than did polyglycolic acid. On day 28, none of these parameters was measurable in polyglycolic acid. Monofilament nylon had the lowest breaking strength of the three materials tested on day 28.

Animals↗
PubMed2000

Guided tissue regeneration with bioabsorbable barriers: intrabony defects and class II furcations.

BACKGROUND: The aim of this study was to compare the effects of guided tissue regeneration (GTR) using 2 different bioabsorbable barriers (control: polylactide acetyltributyl citrate; test: polydioxanon). The polydioxanon barrier is an experimental membrane for GTR therapy that consists of a continuous occlusive barrier that has a layer of slings on the side that is meant to face the mucoperiosteal flap. METHODS: In 21 patients with 22 pairs of similar contralateral defects (30 intrabony and 14 Class II furcation lesions), each defect was randomly assigned for treatment with either control (c) or test (t) devices. At baseline and 12 months after surgery, clinical measurements, plaque index (PI) gingival index (GI), probing depth (PD), and vertical and horizontal clinical attachment loss (CAL-V; CAL-H) and standardized radiographs were obtained. RESULTS: Barrier exposure was commonly observed in both groups. Four weeks after surgery 61% of all barriers were exposed to some extent. However, both treatments revealed a significant GI reduction (P <0.005), PD reduction (-3.08 +/- 2.29 mm [t]; -3.52 +/- 2.67 mm [c]; P <0.001) and CAL-V gain (2.44 +/- 2.29 mm [t], 2.80 mm +/- 2.21 [c]; P <0.001) 12 months after surgery in all defects. Within the intrabony defects significant bony fill (2.03 +/- 1.70 mm [t]; 1.91 +/- 1.20 mm [c]; P = 0.001), and within the furcations a significant but small CAL-H gain (0.79 +/- 0.68 mm [t]; 1.13 +/- 1.44 mm [c]; P <0.05), was observed. CONCLUSIONS: Regarding GI and PD reduction as well as CAL-V and CAL-H gain, this study failed to reveal statistically significant or clinically relevant differences between test and control 12 months postsurgically. Thus, the use of both bioabsorbable barriers in GTR therapy may be recommended.

Absorbable Implants↗
PubMed2006

Evaluation of the gross and histologic reactions to five commonly used suture materials in the skin of the African clawed frog (Xenopus laevis).

Surgical harvest of Xenopus laevis oocytes for developmental research is a common procedure that requires closure of a 0.5- to 2.0-cm incision with suture material. Although such harvests are a frequent practice, little published information exists to provide guidance regarding the most appropriate suture material for wound closure in laboratory amphibians. To determine which suture material elicits the least response in amphibian skin, we used Xenopus laevis as a model to investigate the gross and histologic tissue reactions to 5 commonly used suture materials-3-0 silk, monofilament nylon, polydioxanone, polyglactin 910, and chromic gut. The skin reacted in 3 ways to suture material, showing edema, epidermal changes, and inflammation. Although the gross reactions to monofilament nylon, polydioxanone, and polyglactin 910 were clinically indistinguishable and were associated with lowest gross reaction scores, monofilament nylon elicited the least histologic reaction and therefore seems to be the most appropriate choice for use in amphibian skin.

Animals↗
PubMed1991

Strength retention of chromic gut and synthetic absorbable sutures in a nonhealing synovial wound.

The rate at which absorbable sutures lose their mechanical strength in a slow healing wound is clinically important, particularly because the factors inhibiting normal healing are not always apparent at the time of closure. Sutures of chromic catgut and two monofilament absorbable synthetic suture materials (polydioxanone and polyglyconate) were used to close a synovial incision in the knees of sheep. A corticosteroid was applied around the wound resulting in minimal tissue healing when the sutures were retrieved up to six weeks later. The failure load and maximum tensile strength of the retrieved sutures were measured. The mechanical degradation of the materials followed a pattern similar to that in normally healing wounds except that the early fragmentation of chromic gut and polydioxanone occurred far less frequently and neither weakened further after three weeks. Polyglyconate was significantly the strongest material up to three weeks but thereafter continued to weaken. The strength of absorbable sutures was retained longer than in a healing lesion probably because of the absence of the phagocytic cells of an inflammatory tissue.

Animals↗
PubMed1991

[Early results of transversalis-plasty. A prospective randomized comparison of non-resorbable and resorbable sutures].

In a prospective randomized trial we analyzed the perioperative management, complications, and the recurrence rate of inguinal hernia repair using either resorbable (polydioxanone, PDS) or non-absorbable (polyamide, Ethilon) suture material. From January 1988 to June 1989, 484 consecutive transversalis fascia repairs were performed in 425 adult patients with inguinal or femoral hernia. Local anaesthesia was used in 273 cases. At least one year postoperatively, 390 patients with 445 repairs had a clinical follow-up. The recurrence rate after 360 primary herniae was 3.3% (Ethilon 2.3%, PDS 4.3%) while 5.9% rerecurrences were found following operation for recurrent hernia (Ethilon 2.5%, PDS 8.9%). The differences in the recurrence rates following the use of polyamide or polydioxanone were not statistically significant. Complications occurred in 5.2%. The postoperative hospital stay averaged 3.8 days and work was resumed after a mean of 3.9 weeks.

Adolescent↗
PubMed1989

Strength retention of chromic gut and monofilament synthetic absorbable suture materials in joint tissues.

The rate at which absorbable sutures lose their mechanical strength in vivo is particularly important in orthopedic applications where high physical loads, often increased by early mobilization, severely test the strength of sutures. The failure load and maximum tensile strength of chromic catgut and two monofilament absorbable synthetic suture materials (polydioxanone and polytrimethylene carbonate) were measured up to six weeks after implantation in sheep as: (1) a suture securing a synovial incision and (2) coils located either within the synovial cavity of the knee or intramuscularly. Although all synovial wounds healed satisfactorily, the performances of the different materials varied. The strength of chromic gut was largely lost within a week and fragmentation occurred at Week 4. The synthetic materials lost their strength relatively slowly. Polytrimethylene carbonate degraded in a linear manner, remaining intact but with little strength by Week 6. Polydioxanone, though losing strength at a slower rate, tended to fragment early, which may be of clinical importance in situations of delayed wound healing.

Animals↗
PubMed1986

The use of absorbable suture: morphological findings in a newborn three months after coarctation repair.

The macroscopic and histological findings in a case of surgical repair of aortic coarctation in a newborn, performed using polydioxanone, a monofilament absorbable suture material, are reported. The persistence of suture material three months after surgery, the lack of severe inflammatory changes, calcification and elastic disruption of the arterial wall, confirm previous experimental data. For these characteristics, the use of polydioxanone in the repair of aortic coarctation in newborns is suggested, in order to avoid recoarctation, the most frequent complication of this surgical therapy.

Absorption↗
PubMed1985

Comparison of the healing of prescrotal urethrotomy incisions in the dog: sutured versus nonsutured.

Comparison was made of the healing of sutured prescrotal urethral incisions (12 dogs) with that of nonsutured incisions (6 dogs). Comparison was also made of the healing of 5-0 polyglactin 910-sutured urethral incisions (6 dogs) with that of 5-0 polydioxanone-sutured incisions (6 dogs). Three dogs from each treatment group were euthanatized 3 weeks and 6 weeks after the surgical procedure. Surgical sites were examined grossly, and urethral circumference measurements were taken at 3 locations (surgical site, 1 cm cranially, and 1 cm caudally). Transverse sections of the surgical sites were prepared and examined by light microscopy. Hemorrhage occurred postoperatively in dogs in which the incisions were not sutured. The surgical sites from the 6 dogs in which incisions healed by second intention had more fibrosis and less inflammation than did those that were sutured. There was little difference between incisions sutured with polyglactin 910 and those sutured with polydioxanone suture material. Postoperative urethral stricture formation did not occur in any of the dogs.

Animals↗
PubMed1984

Assessment of sutures for use in colonic surgery: an experimental study.

Following injury, normal colon takes approximately 30 days to regain full breaking strength. This healing period can be lengthened by local infection. Colonic anastomoses are likely to be contaminated by intraluminal organisms, and suture material in such a situation is known to potentiate the development of sepsis. Experiments were designed to evaluate six suture materials used in colonic surgery to determine which retained adequate tensile strength and which excited least inflammatory response. The results indicate that absorbable sutures, with the exception of polydioxanone, lose strength too rapidly for use alone. Braided materials, notably silk, produce a prolonged tissue response and harbour bacteria. Monofilament materials are unreactive and appear least likely to delay healing. Polydioxanone, which is monofilament and absorbable, is recommended for use in the colon.

Animals↗
PubMedDate not supplied

Growth of tracheal sutures with absorbable sutures in primates.

Postoperative wound healing is studied after tracheal suturing in 5 primates operated on in two stages. First by double level hemisection comparing continuous and interrupted sutures with polydioxanone. In a second stage: comparison of continuous sutures after tracheal segmental resection. The tracheas were harvested sequentially to study the evolution of the sutured zone by measuring its diameter and by histopathologic examination. The reduction of the tracheal diameter observed was not statistically significant after hemisection using continuous (p = 0.7) or interrupted sutures (p = 0.6). But after tracheal resection the stenosis was significant with continuous sutures (p < 0.05). Histologic study revealed that polydioxanone is well tolerated and is absorbed within 26 weeks. The authors recommend the use of continuous sutures to repair simple wounds and of interrupted sutures after tracheal resection anastomosis.

Animals↗
PubMed1995

Mechanical factors influencing the incidence of burst abdomen.

OBJECTIVE: To compare laparotomy closure with interrupted polyglactin 910 (Vicryl) and continuous polydioxanone (PDS II), and assess the mechanical and other factors that influenced the incidence of burst abdomen. DESIGN: Retrospective study. SETTING: University hospital, The Netherlands. SUBJECTS: A random sample of 346 patients who did not burst their abdomens, taken from the total of 3768 patients who underwent primary midline laparotomy from 1986-1990, together with the 45 (1%) from the total series who did burst their abdomens. MAIN OUTCOME MEASURES: Incidence of burst abdomen, and the association with mechanical and others risk factors. RESULTS: There were no differences in the incidence of burst abdomen between those sutured with interrupted polyglactin 910 and those sutured with continuous polydioxanone (p = 0.12). Layered closure resulted in significantly more burst abdomens than any other method of closure (p < 0.001 in each case). Postoperative wound infection (14/43, 33%, compared with 33/343 10%) and pulmonary complications (25/43, 58%, compared with 44/344, 13%) were also significantly associated with the development of burst abdomens (p < 0.001). CONCLUSIONS: A continuous, monofilament, absorbable suture should be used to close a laparotomy incision. Elastic suture material, loop sutures, an the continuous figure-of-eight technique should be investigated.

Abdomen↗
PubMed1987

Fascia closure after midline laparotomy: results of a randomized trial.

Four techniques to close the fascia after midline laparotomy were compared in a prospective randomized multicentre trial. The four techniques were: interrupted closure with polyglactin; continuous closure with polyglactin; continuous closure with polydioxanone-s, and continuous closure with nylon. The early postoperative results in 1491 patients revealed an incidence of wound infection of 8.6 per cent and of wound dehiscence of 2.3 per cent with no statistically significant differences between the four techniques. We reviewed 1156 patients after 1 year. Wound pain was present in 9.7 per cent of the patients, statistically significantly more in the group closed with nylon (16.7 per cent). Suture sinuses developed in 3.5 per cent of the patients, statistically significantly more frequently in the nylon group (7.7 per cent). The total number of incisional hernias detected 1 year postoperatively was high (15.2 per cent) (interrupted polyglactin 16.9 per cent, continuous polyglactin 20.6 per cent, continuous polydioxanone 13.2 per cent and continuous nylon 10.3 per cent). The difference between nylon and continuous polyglactin is statistically significant. The results of this trial indicate that although nylon has the lowest incidence of incisional hernia it also is associated with more wound pain and suture sinuses.

Abdomen↗
PubMed2001

Regulation of matrix metalloproteinases in a model of colonic wound healing in a rabbit.

PURPOSE: Matrix metalloproteinases occur in the colon at an anastomosis but not in the normal colon. Matrix metalloproteinase synthesis can be regulated by cytokines, for example interleukin-1 beta and growth factors, such as transforming growth factor beta and basic fibroblast growth factor. The aim of this study was to investigate the regulation of matrix metalloproteinases at an anastomosis by identifying the cell types that synthesize matrix metalloproteinases, examining factors that might regulate their synthesis, determining whether they occur in an active form, and assessing the effect of suture type on these parameters. METHODS: An anastomosis was formed in the distal colon of rabbits using either polyglactin or polydioxanone and the animals were killed six hours or seven days later. The distribution of matrix metalloproteinases and cytokines and the cell types were assessed by immunohistochemistry. Matrix metalloproteinase-2, matrix metalloproteinase-3, and matrix metalloproteinase-9 were detected also by zymography. RESULTS: Immunohistochemistry showed that matrix metalloproteinases were restricted to the suture line. Although zymography demonstrated that matrix metalloproteinase-2 was present mainly in an active form, matrix metalloproteinase-9 and matrix metalloproteinase-3 were present in the pro-form. The active form of matrix metalloproteinase-3 occurred more often in the polydioxanone-sutured rabbits. With the exception of matrix metalloproteinase-9, the matrix metalloproteinases were synthesized by fibroblasts. Interleukin-1 beta and transforming growth factor beta were more widespread than in the normal colon and were localized adjacent to the matrix metalloproteinases. Basic fibroblast growth factor was also more widespread postoperatively but occurred deeper in the anastomosis than the matrix metalloproteinases. CONCLUSIONS: This study has shown that interleukin-1 beta and transforming growth factor beta may regulate the synthesis of the matrix metalloproteinases by fibroblasts and that minor differences that occur in the matrix metalloproteinase profile are dependent on the suture type.

Anastomosis, Surgical↗
PubMed1990

Feasibility of reversible pulmonary artery banding: early results and intermediate-term follow-up.

Development of a reversible pulmonary artery band might obviate the need for a second cardiac surgical procedure in children with some forms of congenital heart disease. We evaluated a segmented Silastic-coated Dacron mesh band 2 to 4 mm wide sewn together with absorbable 2-0 polydioxanone suture for use as a reversible pulmonary artery band. Nine puppies 6 to 8 weeks old (mean weight, 5.8 kg) underwent placement of this pulmonary artery band. All survived the operation with a mean initial systolic gradient of 6.5 +/- 1.6 mm Hg and underwent cardiac catheterization at monthly intervals for 3 months. Two puppies died of right ventricular failure. The remaining puppies underwent balloon angioplasty with balloons 20 to 25 mm in diameter. No complications resulted from balloon angioplasty, but 1 puppy died 24 hours later of unidentified causes. Balloon angioplasty decreased the mean gradient from 46.7 +/- 6.8 mm Hg to 6.7 +/- 2.6 mm Hg. Angiography showed an increase in mean diameter of the site of the pulmonary artery band from 5.2 +/- 1.0 to 10.8 +/- 1.7 mm Hg. There was no evidence of vessel injury on angiograms. Fourteen months after balloon angioplasty, the mean gradient was 22.3 +/- 17.0 mm Hg. Our data demonstrate that a functionally reversible pulmonary artery band constructed of segmented Silastic-coated Dacron mesh and 2-0 polydioxanone suture is feasible.

Angioplasty, Balloon↗