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PubMed2006

Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination?

BACKGROUND: Surgical site infections are associated with severe morbidity and mortality. The role of surgical sutures in the etiology of surgical site infection has been the objective of discussion for decades. This study used a standardized in vitro microbiologic model to assess bacterial adherence and the antibacterial activity of a triclosan-coated polyglactin 910 (braided) suture against selected Gram-positive and Gram-negative clinical isolates that may infect surgical wounds. STUDY DESIGN: Standardized cultures (2.0 log(10) colony forming units/mL and 5.0 log(10) colony forming units/mL of three clinical strains, Staphyllococcus aureus (methicillin-resistant S aureus [MRSA]), S epidermidis (biofilm-positive) and Escherichia coli (extended-spectrum beta-lactamase [ESBL]-producer) were inoculated to triclosan-coated and noncoated polyglactin 910 sutures to evaluate comparative adherence of bacterial isolates to the antibacterial coated and noncoated surgical sutures; to assess the impact of serum proteins (bovine serum albumin) on antibacterial activity of triclosan-coated suture; and to document the duration of antibacterial activity of the triclosan-coated material. Selected suture samples were prepared for scanning electron microscopy to demonstrate bacterial adherence. RESULTS: Substantial (p < 0.01) reductions in both Gram-positive and Gram-negative bacterial adherence were observed on triclosan-coated sutures compared with noncoated material. Pretreatment of surgical sutures with 20% BSA did not diminish antibacterial activity of the triclosan-coated braided device compared with noncoated suture (p < 0.01), and antibacterial activity was documented to persist for at least 96 hours compared with controls (p < 0.01). CONCLUSIONS: The in vitro model demonstrated a considerable reduction (p < 0.01) in Gram-positive and Gram-negative bacterial adherence to a triclosan-coated braided suture, which was associated with decreased microbial viability (p < 0.001). Because bacterial contamination of suture material within a surgical wound may increase the virulence of a surgical site infection, treating the suture with triclosan provides an effective strategy for reducing perioperative surgical morbidity.

Anti-Infective Agents, Local↗
PubMed1995

Wound breaking strength and healing after suturing noninjured tissues.

BACKGROUND: Many operative procedures involve suturing healthy, previously nontraumatized tissues. The present study was done to investigate the wound breaking strength and healing after suturing noninjured tissues. STUDY DESIGN: A new experimental model of muscluloaponeurotic suture in the mouse is described and used to investigate the scar breaking strength, the concentration of 5-hydroxyproline, the extrusion of suture material, and the histological characteristics of the repair process. Scar quality was compared at three weeks between a group of mice in which suture was done without prior tissue injury (n = 24) and three groups of mice (n = 24 each) with prior tissue injury (tight-ischemic suture, incision, and cautery). Silk (n = 8), polyglactin 910 (n = 8), and polypropylene (n = 8) sutures were used within each group. RESULTS: Scars resulting from the suturing of healthy tissues had less breaking strength than those with ischemic, incised, or cauterized wound edges (507 g compared to 590, 730, and 732 g, respectively; p < 0.001) and had a lower 5-hydroxyproline concentration (5.1 ng/mg compared to 6.09, 6.77, and 7.49 ng/mg, respectively; p < 0.01). Polypropylene sutured scars had a higher breaking strength than silk (690 compared to 608 g, p < 0.01) or polyglactin 910 (690 compared to 626 g, p < 0.01). Most of the stitches were extruded from the scar independent of the suture material. CONCLUSIONS: The quality of a scar does not seem to be as good when wound edges are healthy than when they have been previously injured.

Animals↗
PubMed1999

Comparison of the breaking strength of polyglactin mesh in urine, serum, and cell culture media.

OBJECTIVES: This study was designed to determine the durability of polyglactin woven mesh in various in vitro environments, including urine, since polyglactin 901 mesh has been considered for implementation in urinary tract reconstruction. METHODS: Segments of 1 x 1-cm sterile woven and knitted polyglactin 910 mesh with and without collagen coating were exposed to the following conditions: dry (at room temperature and at 37 degrees C, humidified air), in porcine and human serum and urine, in porcine urine over a range of pH levels, in infected urine, in cell culture media (MCDB 105 with 5% fetal bovine serum), and in cell culture media with porcine bladder fibroblasts. The mesh breaking strength was measured at 0, 12, 21, 28, and 36 days. RESULTS: The mean breaking strength for dry, room temperature mesh segments measured 350 g for all time intervals. At day 21, the breaking strength for all mesh types in human and porcine serum, cell culture media, and cell culture media with bladder fibroblasts was less than 10% of the control, but the human and porcine urine maintained 12% to 24% of the control breaking strength (this difference did not reach statistical significance). There was no significant difference in the breaking strength in human and porcine urine or human and porcine serum. By day 38, the breaking strength for all mesh types in all solutions was less than 5% of the control breaking strength. The presence of fibroblasts increased the rate of degradation of the mesh compared with the urine, serum, and cell culture media alone. There was a significant prolongation of degradation with decreasing pH, as well as with infected urine. This prolongation was additive; in fact, all mesh types in low pH (5.0), infected urine showed minimal degradation at 38 days. CONCLUSIONS: In acidic infected urine, the durability of polyglactin 910 mesh is significantly prolonged compared with the other conditions tested. Therefore, when used in urinary tract reconstruction, as in other organ systems, the integrity of the polyglactin mesh should diminish rapidly after 3 weeks as long as the urine is kept sterile and a neutral to alkaline pH is maintained.

Animals↗
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↗
PubMed1998

[A biomechanical study of anterior cruciate ligaments reconstructed with patella tendons augmented by absorbable artificial materials. A biomechanical study in rabbits].

The purpose of this study was to investigate the biomechanical properties of anterior cruciate ligament (ACL) reconstruction using an absorbable artificial material in rabbits. Experimental studies were carried out on 58 New Zealand white rabbits. After total resection of ACL, 22 knees were reconstructed with patella tendons alone (non-augmented group) and 27 knees with patella tendons augmented by polyglactin 910 mesh (augmented group). The animals were sacrificed for biomechanical testing at 0, 2, 4, 6, 8, 12 and 24 weeks, respectively, after the operation. The stiffness of reconstructed ACL in the augmented group showed a mean of 26.58 +/- 5.78 N/mm at 8 weeks, and that of the non-augmented group 16.47 +/- 11.34 N/mm. There were significant differences between the augmented and non-augmented groups (p < 0.05). The ultimate load and energy of the reconstructed ACL were also significantly higher in the augmented group than in the non-augmented group at 8 weeks. The mean elastic module was higher in the augmented than in the non-augmented group, but the differences were not significant. The mean tan delta of both groups was significantly higher than that of the normal ACL at 24 weeks. These results suggests that polyglactin 910 mesh induces earlier maturation of transplanted patella tendons biomechanically, and may be a useful material for ACL reconstruction.

Animals↗
PubMed1980

[In vivo studies on the tensile strength loss of absorbable synthetic threads].

In a total of eight experimental groups, PGS, PGS-S, PGS-C, and polyglactin 910 sutures were implanted subcutaneously in rats. The sutures were either sterile or contaminated with staphylococcus. They were removed after 7, 14, 21, and in two groups after 28 days. The linear loss of tensile strength was tested by means of an electronic tensile strength measuring machine. In four additional groups, the same studies were carried out with paraffinized PGS sutures and in localizations in stomach, duodenum and colon. The diameter of the filament has an effect on the loss of tensile strength: initially more rapid in fine filaments and later, retarded in comparison to thicker filaments. Coating of the suture has almost no influence on tensile strength, although contaminated sutures show a comparative decrease. In intraenteral localizations, loss of tensile strength can be expected to occur much more rapidly than in subcutaneous ones. Paraffinization does not delay decrease in tensile strength. Polyglactin 910 sutures of the second generation employed subcutaneously, show a much higher loss of tensile strength on the day 7 than PGS sutures; by day 28 the relationship is reversed.

Animals↗
PubMed1997

[Anterior cruciate ligament reconstruction with the patellar tendon augmented by absorbable artificial materials. A histological and molecular biological study in rabbits].

An experimental study was performed to investigate the histological and molecular biological properties of reconstructed anterior cruciate ligaments (ACL) using the patellar tendon augmented by absorbable artificial material in rabbits. Thirty rabbits underwent ACL reconstruction with the patellar tendon (non-augmented group), and 30 with the patellar tendon augmented by a polyglactin 910 mesh (augmented group). They were respectively sacrificed at at 1, 2, 3, 4, 6, 8 and 12 weeks after surgery for histological and molecular biological examination. Histologically, the fibrocytes were disappeared in deep portion of transplanted graft at 2 weeks after surgery in both groups. The graft was replaced with granulated tissues at 6 weeks in the augmented group, but it took 8 weeks in the non-augmented group. At 12 weeks, the graft showed hypocellularity with regularly oriented fibers in the augmented group, while it still showed hypercellularity with disoriented fibers in the non-augmented group. Molecular biologically, after the reconstruction at one week, the relative radioactivity in the graft was 1.05 in the non-augmented group, and 2.10 in the augmented group. Additionally the level of the alpha 2 (I) collagen mRNA was also significantly higher in the augmented group than that in the non-augmented group. These results suggested that a polyglactin 910 mesh had an effect on the process of reorganization and remodeling in the transplanted patellar tendon during the post-operative period in rabbit.

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↗
PubMed1995

[Results of a controlled trial comparing 3 suture threads at slow resorption for the closure of supra-umbilical midline laparotomies].

A randomized prospective trial was carried out between September 1987 and February 1989 to compare 3 different absorbable sutures (polyglactine 910, polydioxanone I, polydioxanone II) for closure of the abdominal wall after upper midline laparotomy for elective operations. The technique used to close the fascia was always a continuous suture. The criteria used to assess the results were the development of wound infection and wound dehiscence in the early postoperative period, and the development of suture sinuses and incisional hernia 1 year after operation. The early postoperative results in 235 patients revealed no wound infection and no -wound dehiscence. Suture sinuses developed in 4 patients (2%) 2 months after operation, but resolved spontaneously. We reviewed 203 patients after one year. The total number of incisional hernias detected 1 year postoperatively was 22 cases (11%), (polyglactine 910, 14.2%; polydioxanone I, 11.2%; polydioxanone II, 8.4%). The difference between the 3 groups was not statistically significant. The results of the trial indicate that absorbable sutures have a very low incidence of suture sinuses, and that polydioxanone II seems to be a good choice for closing laparotomies.

Adult↗
PubMed2001

Anterior colporrhaphy: a randomized trial of three surgical techniques.

OBJECTIVE: The purpose of this study was to compare outcomes after anterior colporrhaphy with the use of 3 different surgical techniques. STUDY DESIGN: One hundred fourteen women with anterior vaginal prolapse were randomly assigned to undergo anterior repair by one of 3 techniques: standard, standard plus polyglactin 910 mesh, or ultralateral anterior colporrhaphy. Before and after operation, patients underwent physical examination staging of prolapse; the International Continence Society system was used. Symptoms were assessed by questionnaire and visual analog scales. We defined "cure" as satisfactory (stage I) or optimal (stage 0) outcome at points Aa and Ba. RESULTS: Of 114 patients who were originally enrolled, 109 patients underwent operation, and 83 patients (76%) returned for follow-up. Mean age (+/- SD) was 64.7 +/- 11.1 years. At entry, 7 patients (7%) had stage I anterior vaginal prolapse; 35 patients (37%) had stage II anterior vaginal prolapse; 51 patients (54%) had stage III anterior vaginal prolapse; and 2 patients (2%) had stage IV anterior vaginal prolapse. At a median length of follow-up of 23.3 months, 10 of 33 patients (30%) who were randomly assigned to the standard anterior colporrhaphy group experienced satisfactory or optimal anatomic results, compared with 11 of 26 patients (42%) with standard plus mesh and with 11 of 24 patients (46%) with ultralateral anterior colporrhaphy. The severity of symptoms that were related to prolapse improved markedly (preoperative score, 6.9 +/- 2.7; postoperative score, 1.1 +/- 0.8). Twenty-three of 24 patients (96%) no longer required manual pressure to void after operation. CONCLUSION: These 3 techniques of anterior colporrhaphy provided similar anatomic cure rates and symptom resolution for anterior vaginal prolapse repair. The addition of polyglactin 910 mesh did not improve the cure rate compared with standard anterior colporrhaphy.

Aged↗
PubMed2001

Nonresorbable versus resorbable sutures in oral implant surgery: a prospective clinical study.

BACKGROUND: Regarding the Brånemark implant system, nonresorbable sutures have been advocated for reapproximation of the flaps. Fast-absorbable sutures are frequently used in oral surgery, which is convenient for both the patient and the surgeon. It would be advantageous if fast-absorbable sutures are suitable in implant surgery as well. PURPOSE: The purpose of this study was to compare irradiated polyglactin 910 (Vicryl Rapide, Ethicon GmbH, Norderstedt, Germany) suture with a nonresorbable polyfilament suture (Supramid, Schwarz, Resorba GmbH, Nürnberg, Germany) used in oral implant surgery. MATERIALS AND METHODS: The study comprised 101 edentulous patients (52 females, 49 males) who were provided with 350 Brånemark implants. They were randomized to receive either Vicryl Rapide suture (n = 61) or 3-0 Supramid suture (n = 40). The patients were evaluated after 10 days and at the time of abutment surgery. Any wound complications and implant losses were recorded. RESULTS: The implant failure rate at abutment surgery was low (1.2%), and no difference was seen between the two suture groups. A higher incidence of complications (mainly wound dehiscence) was found in the absorbable suture group, especially when a continuous suture was used. CONCLUSIONS: The results of this study indicate that it is possible to use irradiated polyglactin 910 sutures in oral implant surgery without affecting the rate of early implant failure. However, it is recommended to add interrupted "security sutures" if a continuous suture technique is used in combination with fast-absorption suture material.

Absorbable Implants↗
PubMed1994

Adherence of oral microorganisms to guided tissue membranes: an in vitro study.

Microorganisms can adhere and colonize on an exposed guided tissue regeneration (GTR) membrane thus developing a nidus of infection. The purpose of this study was to compare early bacterial adhesion to three different GTR membranes. Expanded polytetrafluoroethylene, polyglactin 910, and collagen were used as the test membranes. In part I of this study 15 different oral microbes were used to compare their relative ability to adhere to the membranes. Six of the most strongly adherent bacteria (Actinomyces viscosus, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans, Fusobacterium nucleatum, and Selenomonas sputigena) were selected for part II of this study. The membranes were placed in tubes containing broth cultures containing identical concentrations (1 x 10(8) cells/ml) of these bacteria at 37 degrees C. Membranes were placed in tubes of media without bacteria as controls. At 4, 6, 12, and 24 hours, the bacterial cultures were decanted and the membranes in the tubes were agitated gently in reduced transfer fluid (RTF) 4 times to remove non-adherent bacteria. Each tube was then sonicated for 30 seconds in 10 ml RTF to detach adherent bacteria. The detached adherent bacteria were counted using a Petroff-Hausser chamber. Data were analyzed by using the SAS program. Analysis of variance was used to test for differences between multiple means. Results showed S. mutans had the strongest attachment to the collagen membrane at 4 and 6 hours. Selenomonas sputigena had the lowest adherence capability to all test membranes. Polyglactin 910 had significantly (P < 0.05) lower S. mutants adherence than either the ePTFE or the collagen membrane at 4 and 6 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Actinomyces viscosus↗
PubMed1998

Periodontal surgery of vertical bony defects with or without synthetic bioabsorbable barriers. 12-month results.

The aim of the present study was to clinically and radiographically compare guided tissue regeneration (GTR) therapy with bioabsorbable polyglactin 910 barriers and conventional periodontal surgery in intrabony defects. In 26 patients with advanced periodontitis, 29 teeth exhibiting interproximal intrabony defects were treated; 15 by conventional periodontal surgery (control) and 14 by GTR (test). Before and 12 months after surgery, clinical parameters were assessed and standardized radiographs were taken. On the radiographs the distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), and the CEJ to the most apical extension of the bony defect (BD) were measured using a computer-assisted analyzing device (LMSRT). Twelve months after surgery, 24 patients with 27 lesions were available for examination. For both methods statistically significant (P < 0.001) probing depth (PD) reduction (mean +/- standard deviation) of -4.49 +/- 1.94 mm (n = 13, test) and -3.22 +/- 1.48 mm (n = 14, control), as well as clinical attachment gain (CAL-V) of 3.41 +/- 1.59 mm (test) and 2.07 +/- 1.10 mm (control), was observed. Radiographic changes of the distance CEJ to AC of -0.95 +/- 1.72 mm (n = 9, test), and -0.98 +/- 1.53 mm (n = 11, control) were not significant. A significant bony fill (distance CEJ-BD) of 1.05 +/- 1.22 mm was observed for the test group (P < 0.01); the 0.68 +/- 2.04 mm bony gain for the control group was not statistically significant. The PD reduction (P < 0.05) and attachment gain (P < 0.01) in the test group was statistically significantly more favorable than in the control group. Twelve months after surgery, statistically more favorable PD reduction and attachment gain was observed using polyglactin 910 barriers than compared to conventional flap surgery. Hence, the use of bioabsorbable barriers for therapy of intrabony defects may be recommended.

Absorbable Implants↗
PubMed2000

Expression of heat shock protein 70 (HSP70) at the interface of polymer-implants in vivo.

Synthetic polymer meshes are widely applied in the modern surgical approach for repairing abdominal wall defects. The implanted material is often observed leading to post-operative complications such as deficient abdominal wall mobility and adhesion formation with the abdominal cavity and/or abdominal organs. However, the functioning of the implant is primarily affected by the wound healing process guided by inflammatory events occurring at the tissue-material interface. This could presumably be influenced by the physicochemical properties of the polymer. With regard to it, the cellular and molecular processes involved in the successful restoration of the abdominal wall function are poorly understood. The present in vivo study, therefore, exemplary investigated in a rat model, the commercially available polymer-meshes Prolene (polypropylene, PP), Mersilene (polyester, PE) and Vicryl (polyglactin 910), as well as new mesh variants consisting either of PP (EB) or a combination of PP and polyglactin 910 (A plus or Vypro). The implanted material was evaluated by light and electron microscopy, immunohistochemistry as well as morphometry over an implantation period of 90 days. The data show that polymers induce heat shock protein (HSP)70, and its expression at the interface correlates inversely with the activity of the inflammatory reaction in vivo. Further, an ascent in HSP70 expression parallels the increasing implantation period and evolving foreign-body granulomas. Accordingly, a major role for HSP70 in modulating the local acceptance of polymers and as an additional marker for in vivo testing of polymers is suggestive.

Journal Article↗
PubMed2001

[Implantation of synthetic mesh for the closing of abdominal wall ruptures in the ventral flank of cows: a retrospective study of 16 cases].

In this paper the technique and long-term results for abdominal wall ruptures in the ventral flank are described in 16 cows that underwent surgery between January 1990 and October 1999. Most injuries were caused by a horn of another cow. In three cases the rupture was repaired longer than 6 weeks after traumatic injury. The other defects were treated surgically 6.4 (0-25) days after they occurred. The muscle defects were closed layer by layer with simple continuous sutures (polyglactin 910, 6 metric) under general anesthesia in lateral recumbency and the sutured defect was reinforced with a synthetic mesh (polyester or polyglactin 910) fixed to the outside of the external oblique abdominal muscle. The most frequent postoperative complication was subcutaneous seroma. It was treated successfully by incision and drainage. All patients were released 11.6 +/- 5.5 (6-23) days after surgery. A telephone survey 53 +/- 26 (7-106) months after surgery revealed that the patients had an average survival time of 30 (2-104) months, had born one to seven calves without any complications and that only one cow had had an unsatisfactory milk yield. One cow had to be slaughtered 2 months after surgery because of a relapse. Synthetic mesh was used successfully to close the defect in 15 animals. The functional as well as the cosmetic result of the described operation was good to excellent.

Abdominal Muscles↗
PubMed2006

[Episiotomy techniques].

OBJECTIVES: To describe the different types of episiotomy and to define the methods of repair. METHODS: A systematic review on Medline and Cochrane Database between 1980 and August 2005 was performed. RESULTS: Aseptic prevention and specific material may be used in order to reduce the risk of surgical wound infection (grade C). Episiotomy and perineal repair may be associated with considerable pain. In contrast, there has been little evaluation of the effectiveness of analgesia provided to women undergoing this procedure. The mediolateral episiotomy is a 6 cm incision at a 45 degrees angle from the inferior portion of the hymeneal ring (professional agreement). However, shorter length and lower angled episiotomies are also currently reported for routine practice (grade C). There are no data to recommend preferential use of an absorbable synthetic material (acid polyglycolic versus polyglactin 910). The use for the more rapid polylactin 910 suture material was associated with less need to remove sutures but with more wound gapping in comparison with the standard polyglactin 910 material (grade A). The continuous subcuticular technique of perineal repair may be associated with less pain in the immediate postpartum period than the interrupted technique (grade A). CONCLUSION: Mediolateral episiotomy is the method of choice in France. However, the procedure for this technique should be studied more. Subcuticular technique with an absorbable synthetic material may be the optimal method of repair.

Adult↗
PubMed1983

Bursting point of sutured limbal incisions.

The bursting point of standard limbal cataract incisions closed with five or 11 sutures was measured in postmortem eyes with an air gauge and bulb. Bursting point was a minimum of 90 mm Hg when five sutures of either 7-0 polyglactin 910 or 10-0 nylon closed the incision. Eleven sutures increased the average bursting point 55% for nylon and 87% for polyglactin 910. Bursting point was higher for flat than watch-glass-beveled incisions. Wound leak always occurred at pressures well below the bursting point.

Aged↗
PubMed1977

An experimental study of suture of colonic wounds in the rabbit.

It would seem that, during the early phase of healing of a sutured colonic wound in the rabbit when a single layer continuous suture is used, silk results in a significantly stronger wound when compared with polypropylene, polyglactin 910 and chromic catgut of the same gauge, 000. Although at 14 days after operation, no significant differences in wound strength are apparent there appears to be some weakening at 21 days after operation. This is most marked with absorbable sutures, especially polyglactin 910. The mechanism of this is uncertain but may well be at a biochemical level related to collagen maturation. The strength of the suture line bears no correlation whatever to the degree of acute inflammatory reaction or fibrosis excited by the suture material upon histologic examination.

Animals↗