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To fabricate artificial nerves with tissue engineering methods.

OBJECTIVE: To fabricate artificial nerves with tissue engineering methods in vitro. METHODS: Schwann cells (SCs) were cultured and seeded on polyglactin 910 fibers wrapped by biomembrane coated with rat tail glue and laminin for 2 weeks. The absorbability on the scaffolds, growth and migration of SCs were assessed with a light microscope, a scanning electron microscope and a transmission electron microscope. RESULTS: SCs could migrate and proliferate on polyglactin 910 fibers. They were well distributed between scaffolds and absorbed on surface of scaffolds and formed a bungner band, on which SCs produced more matrices. SCs seeded on the biomembrane could also grow well. Axon regeneration in the distal nerve stump was observed at 8 weeks. CONCLUSIONS: Adult SCs can be expanded on coated fibers and biomembrane. Three-dimensional scaffold of SCs has the basic characteristics of artificial nerves. These findings offer a novel method to fabricate artificial nerves with tissue engineering methods for repairing defected long nerves.

Animals↗

Synthetic absorbable suture for strabismus surgery.

Polyglactin 910 (Vicryl), a synthetic absorbable braided suture in 5-0 or 6-0 size, was satisfactory for recession and resection of extraocular muscles. It produced an acute allergic reaction in only one of 89 cases (1.5%) as compared to a 19% reaction when collagen suture of like size was used. Polyglactin 910 suture, when left partially exposed, may be irritating and can cause excessive reaction when used at the conjunctival limbus.

Collagen↗

The use of a biodegradable mesh to prevent radiation-associated small-bowel injury.

Radiation-associated small bowel injury occurs in up to 50% of patients receiving postoperative radiotherapy following pelvic cancer surgery. We describe our experience using a biodegradable mesh that allows the small bowel to be supported above the pelvic inlet and is totally absorbed following radiation therapy. Between 1985 and 1989, 45 procedures were performed in patients with carcinoma of the rectum (anterior resection in 15 patients, abdominoperineal resection in 23 patients, pelvic exenteration in six patients, and proctocolectomy in one patient). In 30 patients a polyglycolic acid (Dexon) mesh was used, and in 15 patients a polyglactin 910 (Vicryl) mesh was used. Forty-four patients received postoperative radiotherapy. The mean (+/- SEM) dose was 56.8 +/- 18.4 Gy. There were no immediate complications related to the mesh. Follow-up ranged from 12 to 53 months (median follow-up, 34 months). With the exception of two patients who had a polyglactin 910 mesh and who developed bowel obstruction due to adhesions under the anterior abdominal wall, there has been no documented incidence of clinical radiation-associated small bowel injury. The use of the absorbable mesh may permit us to use higher doses of postoperative radiotherapy without the associated hazard of radiation-associated small bowel injury.

Adult↗

Tissue reaction and surface morphology of absorbable sutures after in vivo exposure.

Tissue reaction to suture materials depends mainly on how the polymer they are composed of interacts with the tissues. There are few in vivo studies evaluating the suture material modifications resulting from its interaction with tissues. This paper aimed to study rat subcutaneous tissue reaction to irradiated polyglactin 910, polydioxanone, poliglecaprone 25 and chromic gut and its correlation with the ultra-structural alterations the materials undergo. The histological alterations were studied on the 1st, 2nd, 3rd, 7th and 14th day after suture implantations. In these periods, the materials were removed from the tissues and their surfaces were analyzed by scanning electron microscopy. Irradiated polyglactin 910 stimulated the formation of multinucleated giant cells and its filaments underwent cleavage and dissolution. In potydioxanone, a few inflammatory cells and scar fibrosis was observed, and triangular cracks appeared on its surface. Around the poliglecaprone 25, a diffused infiltration of a few mononuclear cells and fibrosis was recorded and formation of craters was observed on its surface. Chromic gut induced necrosis and granulation tissue and underwent dissolution in the tissues during the studied periods. In this study, it was observed that suture materials induced differentiated tissue reactions and morphologic surface changes, suggesting that indications should be individualized.

Animals↗

A comparison of the strength of knots tied by hand and at laparoscopy.

BACKGROUND: The strength of knots tied at laparoscopy was compared with that of hand-tied knots. STUDY DESIGN: The force needed to undo or break eight types of knots that were tied in fresh postmortem human stomachs was measured. The knotting performance of nylon, polyglactin 910, braided silk, polytetrafluoroethylene, braided polyester fiber, braided polyester suture, polyamide 66, and polydiaxone was also compared. RESULTS: Measurements of knot strength of two to six half hitches (hand tied) showed that four half hitches were necessary to tie a secure nonslipping knot with most monofilament threads (nylon, polytetrafluoroethylene, braided polyester suture, and polyamide 66), while three half hitches were adequate to secure a knot when polyglactin 910, braided polyester fiber, silk, and polydiaxone were used. Additional throws did not increase knot strength once the knot no longer slipped (p = NS). Some commonly tied knots, three half hitches and surgical knots at laparoscopy were weaker than the same hand-tied knots (p < 0.05) but an additional throw increased knot security (p < 0.01). Differences between laparoscopic and hand-tied knot strengths were greater for monofilament than multifilament threads. There was a wider distribution of strengths for laparoscopically tied than hand-tied knots. Four half hitches were the most secure configuration for laparoscopically tied knots and were significantly stronger than three half hitches and surgical knots (p < 0.01). The extracorporeally tied slipknot (Roeder loop) was significantly less secure than four half hitches (p < 0.05). CONCLUSIONS: This study demonstrates that laparoscopically formed knots may be weaker than those tied by hand and shows that improvements in knot strength at laparoscopy can be achieved by choice of optimal knot configuration for different suture materials.

Evaluation Studies as Topic↗

Knot security of suture materials.

The knot security of chromic gut, polyglycolic acid, polyglactin 910, polydioxanone, polypropylene, and monofilament nylon size 2-0 suture materials were tested biomechanically in vitro. Twenty reproducible knots were tied and incubated in canine serum at 37 degrees for 24 hours before testing. A "secure knot" was defined as a knot that, when tested to failure, broke rather than untied by slippage. The minimum number of throws necessary to make a secure, snug (1500 g tension) square knot was three for gut, polyglycolic acid, polyglactin 910, and polypropylene and four for polydioxanone and nylon. All throws including the first were counted. With all suture materials tested, surgeon's knots were as secure as square knots. Only gut, polyglycolic acid, and polydioxanone granny knots were as secure as square knots; no loosely tied (500 g tension) asymmetric square knots were as secure as snug square knots, and only polydioxanone and polypropylene loose square knots were as secure as snug square knots. Square knots used to start a continuous pattern required one additional throw with gut, polydioxanone, and nylon. Square knots used to end a continuous pattern required two to three additional throws with all materials tested.

Catgut↗

Autogenous lamellar corneal grafting in dogs.

Lamellar, autogenous, corneal grafts were performed on 9 clinically normal dogs (1 eye in each of 2 dogs and both eyes in each of 7 dogs) and 7 dogs with corneal disease (1 eye in each dog). Nylon, polyglycolic acid, polyglactin 910, and polydioxanone suture materials were used in 8-0 to 10-0 sizes. The eyes of the normal dogs were examined weekly for up to 16 weeks; corneal endothelium was reestablished in all eyes by 6 weeks after surgery. The eyes of the dogs with corneal disease were reexamined periodically for up to 9 months. Twenty-two of 23 (95.7%) grafts were considered successful in that they were translucent, and the dogs were able to see after surgery. The suture materials that caused the least tissue reaction were nylon and polyglactin 910. This procedure is indicated for chronic descemetoceles and other perforating corneal disease. It has the advantage of rapidly resolving severe corneal disease, with a high degree of success.

Animals↗

A comparison of three techniques for closure of pelvic flexure enterotomies in normal equine colon.

Six enterotomies 3 cm long, spaced at 3 cm intervals, were made in the antimesenteric border of the pelvic flexure of the ascending colon in five adult horses. Ten incisions each were sutured with a Utrecht pattern (single layer), a full-thickness simple continuous oversewn with a Cushing pattern (two layer), and a mucosal simple continuous with a seromuscular simple continuous oversewn with a Cushing pattern (three layer). In all horses, chromic gut and polyglactin 910 were each used once for each pattern. On day 6, the pelvic flexure was excised and the colonic vessels were injected with a radio-opaque mass. Sections of each enterotomy were studied by light microscopy and high detail radiography. The single-layer closure led to serosa-to-mucosa healing and a thin bowel wall, and the three-layer closure resulted in distortion of the bowel wall by hematoma formation and submucosal contamination with ingesta. The two-layer closure resulted in good alignment and improved healing. There was less inflammatory reaction with polyglactin 910 than with chromic gut.

Animals↗

Absorbable material in vascular prostheses: a new device.

Seven to twenty cm long bypass grafts were inserted between the upper and lower part of the descending aorts of 20 young pids with end-to-side technique. The aorta between the anastomoses was closed by a ligature. As graft materials were used circular polyglactin 910 (Vicryl) mesh tubes (group I), external PTFE graft (Impra) and internal polyglactin mesh tube (group II), PTFE graft (group III) and external dacron mesh tube and internal polyglactin mesh tube (group IV). The biological process taking place in the grafted area was studied by light microscopy. The following observations were made: (1) The regenerative capacity of the pig aortic tissue permits 7 to 15 cm long polyglactin mesh grafts to be replaced by a new endothelialized vessel wall imitation. (2) When resorbable and non-resorbable materials were combined to form a composite graft (groups II and IV) the result proved to be a prosthesis with an internal covering of endothelialized arterial tissue.

Animals↗

Vypro II mesh in hernia repair: impact of polyglactin on long-term incorporation in rats.

BACKGROUND: To the Vypro II mesh, a large-pore-sized multifilamentous polypropylene mesh for hernia repair, supplementary polyglactin 910 multifilaments were added to improve intraoperative handling. As it has been suggested that polyglactin induces fibroplastic reactions and wound complications, this study was designed to evaluate the long-term tissue reaction to polyglactin in the Vypro II mesh. MATERIALS AND METHODS: Two mesh materials, the Vypro II composite mesh (PP + PG) and the pure polypropylene variant (PP), were compared after inlay implantation in a standardized rodent animal model. After 14, 28, 42, 56, 84 and 112 days of implantation, histological analysis of the inflammatory response was performed: material absorption, inflammatory tissue reaction, fibrosis and granuloma formation were investigated. RESULTS: Total absorption of polyglactin filaments of the Vypro II mesh occurred between 56 and 84 days of implantation. Both the inflammatory and the fibrotic reaction were initially increased in the PP + PG mesh group. These differences disappeared in the following implantation period. After 112 days, inflammation was even less pronounced in the PP + PG mesh group. CONCLUSION: The present data confirm a short-term polyglactin-induced increase in inflammation and fibrosis around implanted Vypro II meshes in rats. With regard to the long-term tissue response, even an anti-inflammatory property of polyglactin multifilaments in low-weight and large-pored polypropylene meshes cannot be ruled out.

Absorption↗

Influence of suture material and suture technique on collagen fibril diameters in midline laparotomies.

BACKGROUND: Although laparotomy closure is associated with a cumulative 15% failure rate, the effect of different suture techniques and materials on the ultrastructural composition of the healing incision has not been investigated. METHOD: in 40 Wistar rats the collagen fibril diameters and the regenerative tissue were compared using electron microscopy 14 and 28 days after midline laparotomy. Wounds were closed with single and running sutures using either polypropylene or polyglactin 910. RESULTS: Closure with polypropylene led to significantly larger mean fibril diameters than closure with polyglactin. Regardless of time and suture material, running closure resulted in significantly smaller mean collagen fibril diameters than single sutures. Four weeks after laparotomy, inflammatory reactions, disorganization of collagen and irregularities of the vascular architecture were found after closure with absorbable suture material but not after closure with nonabsorbable material. CONCLUSION: Suture material and suture method significantly influence the ultrastructural composition of the healing incision. Persisting mechanical irritation around the suture threads after single sutures and severe persisting inflammatory reactions after the use of absorbable suture material are important influencing factors.

Animals↗

[Skin closure in inguinal hernia repair with rapidly absorbing Polyglactin 910/370 (Vicryl-Rapide) suture material].

OBJECTIVE: Results of fast absorbing Poliglactin 910/370 suture material were assessed in skin closure following invaginal hernia repairs. METHODS: Fifty consecutive patients undergoing invaginal hernia repair were prospectively and randomly assigned in two groups. In Group I, wounds were closed with conventional absorbable subcutaneous Polyglactin 910 (VICRYL, ETHICON) and non absorbable cutaneous Monofilament Nylon (ETHILON, ETHICON) stitches. In Group II, running subcutaneous and intradermic irradiated Polyglactin 910/370 (VICRYL-Rapide, ETHICON) sutures were used. The time of skin closure, the price of the suture material, short and middle term cosmetic results, complications in wound healing and the subjective comfort of patients were noted. RESULTS: The cost of skin closing was similar, while the need for further medical wistis was lower in the VICRYL-Rapide group. The wound healing process and it's cosmetic results were similar. Patients in Group II experienced less discomfort, due to the avoidance of suture removal. CONCLUSION: The rapidly resorbing suture material (VICRYL-Rapide) is a cost effective choice for closing the skin of invaginal hernia repairs and probably of other clean operations.

Absorption↗

[Intraperitoneal resorbable mesh in the prevention of postoperative wound dehiscence. A comparative study].

The purpose of this study was to compare efficiency of polyamide mesh externally applied to the skin and intraperitoneal resorbable mesh of polyglactine 910, for the prevention of wound dehiscence. Two consecutive and homogenous groups of 100 patients, operated by the same surgical team and presenting one or more risk factors of evisceration, were retrospectively compared. Use of intraperitoneal polyglactine mesh, significantly reduced rate of wound dehiscence (4% vs 13%), lowered frequency of reoperation in eviscerated patients (25% vs 61%), but did not improve prognosis of this complication (50% mortality). Potential effect of resorbable mesh on late fascial disruption remains controversial.

Aged↗

[The clinical applications of biomaterials].

The more and more availability of new alloplastic materials in oral and maxillo-facial reconstructions causes the necessity of judging if the biomaterials satisfy the surgical needs. The authors re-examine the main chemical, physical and biological characteristics of following materials: hydroxylapatite, polytetrafluoroethylene, polyglactin 910, polyfluorocarbons, polypropylene and report their experiences.

Biocompatible Materials↗

The buried horizontal mattress suture.

The buried horizontal mattress suture (BHMS) is a new tension suture technique using synthetic absorbable polyglactin 910 suture. When used in minor surgery of the trunk and extremities, this technique eliminates significant suture marking.

Dermatologic Surgical Procedures↗

Regeneration of peripheral nerve through a polyglactin tube.

Polyglactin 910, a resorbable synthetic material, was used as a mesh-tube to bridge defects (7 to 9 mm in length) in a sectioned rabbit tibial nerve. After absorption of the mesh a new nerve sheath was formed which enclosed numerous minute fascicles of regenerating axons. The polyglactin tube influenced the direction taken by the regenerating axons and guided them into the distal segment. The tube also reduced the formation of neuromas and the growth of scar tissue from surrounding structures.

Animals↗

Periareolar mammaplasty: double skin technique with application of polyglactine or mixed mesh.

This paper presents the author's experience of 7 years in 254 patients operated on using a personal mammaplasty technique with a periareolar approach. The technique is based on the principle that the skin alone does not prevent early ptosis. This paper proposes the repositioning of all breast connective structures, treating the glandular set separately from the cutaneous lining, which is doubled, applying a circular flap of dermis with the central pedicle to the areolar region. For this purpose, the following structures have been employed, which, once repositioned and together, will act as a support network: (1) anterior pectoral fascia, (2) Cooper's intramammary ligament, (3) periareolar dermal flap, employed as skin inner lining. (4) application of absorbable polyglactine 910 or mixed mesh (with polyester) as a sandwich between both layers of skin, and (5) external cutaneous lining that composes the assembly of double skin.

Adult↗

A new method of stomal reconstruction in patients with retraction of conventional ileostomy.

A new method of stomal reconstruction has been evaluated in three patients with retraction of a conventional ileostomy associated with special problems. A polyglactin 910 mesh has been used for remodeling of the ileostomy. The observation times vary from 20 to 37 months. There has been no recurrence of retraction in any of the patients during this period.

Follow-Up Studies↗