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Reported are 305 patients undergoing 327 intestinal anastomoses with polyglactin 910(Vicryl, Ethicon) suture. The technique of one-layer interrupted absorbable suture anastomosis is discussed. A leak rate of 0.6 percent is recorded and indicates this method is acceptable.
This new synthetic absorbable suture material has been tested in 90 animal experiments (Wistar rats) with regard to tissue reaction, absorption and breaking strength. The data obtained were compared with Polyglactin 910 (Vicryl), Catgut plain and polyester fibres. PDS-sutures produced only a minimal tissue reaction and were completely resorbed after 168 days. They retained 50% of its breaking strength until the 40th day after implantation.
Partial resection of the right atrium was performed in 5 young pigs. The defect was covered with a patch graft of absorbable material (polyglactin 910). Ten weeks postoperatively the mesh was completely replaced by a newly formed tissue with a smooth inner surface. Light microscopy showed regeneration of fibro-elastic tissue and the luminal surface was covered with endothelial-like cells indistinguishable from normal endocardium.
The complex interactions that occur between oligodendrocytes and axons during the process of central nervous system myelination and remyelination remain unclear. Elucidation of the cell-biological and -biochemical mechanisms supporting myelin production and elaboration requires a robust in vitro system that recapitulates the relationship between axons and oligodendrocytes in a manner that is open to molecular dissection. We provide evidence for an artificial axon culture system in which we observed oligodendrocytes extending large plasma membrane projections that frequently completely ensheathed fibers coated with a variety of extracellular matrix molecules. These membrane projections varied in extent and thickness depending upon the substrate and upon the diameter of the coated fiber. Matrigel-coated glass microfibers were found to support the development of thick membrane sheaths that extended for hundreds of microns and exhibited many features suggestive of the potential for true myelin deposition. Likewise, Matrigel-coated Vicryl fibers supported plasma membrane extensions that covered extremely large surface areas and occasionally wrapped the coated Vicryl fibers in more than one membrane layer. Our findings suggest that the deposition of molecular cues onto glass or polymer fibers either via adsorption or chemical modification may be a useful tool for the discovery or validation of axonal factors critical for myelination and remyelination. Herein, we provide evidence that polyglactin 910 and glass microfibers coated with adhesion factors may provide a reasonable system for the in vitro analysis of myelination, and may eventually serve a role in engineering artificial systems for neural repair.
Giant omphaloceles, especially if they contain liver tissue, remain the greatest challenge to pediatric surgeons for the coverage of the huge defect. Various reconstructive techniques have been described in the literature, each with advantages and disadvantages. Standard treatment has been placement of a Silastic silo to allow gradual return of abdominal organs to the abdomen with its limited space. The worst complication of silo placement is infection of the fascia with disruption of the suture line. When fascial infection occurs, closure of the abdominal wall is very difficult or impossible. In this report, the authors describe their experience in treating 5 patients with giant omphaloceles, between 1999 and 2003, utilizing an abs orbable synthetic mesh (polyglactin 910-Vicryl) for abdominal closure and topical application of povidone-iodine 10/100 solution (Betadine) to prevent infection. All patients had perfect results with the simple postoperative care, early oral feeding and were discharged after 2 months of hospitalization with complete skin coverage.
In 20 female rabbits the influence of absorbable and nonabsorbable suture material on microsurgical anastomosis of the oviduct was investigated. No significant superiority of polyglactin 910 over polypropylene could be demonstrated. Concerning histological reaction to the different suture materials as well as pregnancies (calculated by nidation indices) the results were comparable. The modern suture materials obviously do not influence the functional sequelae of microsurgical reanastomosis of the rabbit fallopian tube.
The use of absorbable polyglactin 910 mesh (Vicryl) is described in a case of Ewing's sarcoma of the pelvis. An operation was performed to hold the small bowel and colon out of the pelvis for a temporary period during which radical radiotherapy was delivered. The mesh allowed the temporary displacement of bowel and obviated bowel radiation morbidity.
Mesh of absorbable polyglactin 910 instead of human tissues or nonabsorbable synthetic materials was utilized for retropubic sling procedures in 21 women with urinary stress incontinence. The patients have been observed for a period ranging from 4 to 14 months. 20 of them are continent while there was 1 relapse after 2 months. The postoperative complications were minimal, and there has been no instance of foreign body reaction.
The anterior cruciate ligament reconstruction by a biological graft augmented by a synthetic device allows theoretically to increase the strength of the composite graft during the remodeling period. The technical realization of the reinforcement is still controversial because it is difficult to obtain a mechanical compromise between a real effect of protection of the graft and a load sharing to favour the remodeling. When the graft and the augmentation device are tied together the ligature between them plays a fundamental mechanical role. The first goal of the present study was to define by calculation and experimentation the influence of the suturing method on the strength of the graft-device ligature. The second goal was to appreciate the possibility of using absorbable suture in such an application. Calculation allowed to show that the weakest area of the composite graft was the junction between the augmented and unaugmented parts of the graft. When increasing number and anchorage of sutures in this critical area it was possible to double the resistance of the ligature. To define the outcome of absorbable suture the strength decrease was measured during the resorption period. Two threads were tested: the polyglactin 910 (Vicryl) and the polydioxanon (PDS). The strength decrease was sudden and rapid for the Vicryl (50 p. cent in 3 weeks). For the PDS the strength loss was more gradual (50 p. cent in 8 weeks). With these two threads the strength duration appeared as incompetent to allow the augmentation to protect the graft during all the remodeling period.
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.
Tracheal anastomosis, after circumferential resection, and bronchial anastomosis, after sleeve resection, have become widely accepted procedures. Nevertheless, there appears to be no agreement as to the optimal suture material for these anastomoses. Fifty-two rabbits were operated on, and 10 cervical tracheal rings were resected in each animal. End-to-end anastomosis was performed using 5/0 silk, chronic catgut, Teflon-coated polyester, coated polyglactin 910, polypropylene, or polydioxanone sutures. Twelve rabbits died. Rabbits which survived the intended length of time were evaluated with respect to acute and chronic inflammation and stricture formation. The results suggest that polypropylene is the best suture material, whereas silk is the worst material. Monofilament sutures should be used with caution for bronchial anastomosis, as their bristly knots can perforate adjacent blood vessels.
Absorbable sutures are initially equal or superior to nonabsorbable sutures in terms of tensile strength but are absorbed at variable rates by the action of hydrolysis. This study demonstrated that the in-vivo half-life tensile strength of the braided absorbable sutures polyglycolic acid (Dexon Plus) and polyglactin 910 (Vicryl) is 2 weeks, whereas those of the monofilament absorbable sutures polyglyconate (Maxon) and polydioxanone (PDS) are 3 and 6 weeks respectively. The addition of a single hitch or six knots reduced the in-vitro tensile strength by 30% to 35%. Polyglyconate (Maxon) suture demonstrated the best in-vitro knot security.
Modern technology has recently provided us with new resorbable suture material for use also in vascular surgery. Clinical use of these sutures has been impeded however by not little mistrust and by old dogmas without a rational experimental basis. We have therefore begun studies of two slowly resorbable materials, polyglactin 910 and polyglycolic acid, in comparison with two classic nonreabsorbable materials, nylon and polypropylene, used in experimental model of end-to-end anastomosis rats'infrarenal aorta, following up the healing process and its evolution after an interval. The results are discussed in relation to data collected from current literature.
The surgical insertion of an absorbable sling mesh has become the most promising technique for excluding the small bowel from the pelvis prior to radiotherapy. Both human and animal studies suggest that this procedure is very safe. The author reports what appears to be the first significant mesh-related complication. A 69-year-old man suffered early postoperative complete mechanical small bowel obstruction after insertion of a polyglactin 910 (Vicryl) surgical sling mesh at the time of low anterior resection for a stromal sarcoma of the rectum. Urgent laparotomy was required and revealed that the Vicryl mesh was associated with an intense inflammatory reaction. Radiation therapy is a critical component of contemporary multimodal treatment of patients with rectal cancer. This case suggests that inserting biodegradeable mesh to protect the small bowel from radiation effects is not without complications.
A muscle sleeve fashioned from polyglactin 910 Vicryl mesh was used in a rabbit animal model to evaluate its efficacy in decreasing postoperative adhesions encountered in extraocular muscle surgery. Clinical observations, as well as gross and histological comparison of the experimental and control groups, revealed a significant reduction in postoperative adhesions under conditions of normal surgical trauma. Where there was extensive trauma, however, no significant reduction was observed. No evidence of toxicity of the material to ocular tissues was found.
The case of a 13-year old girl who presented with generalised peritonitis, septic shock and laboratory features of perforated typhoid enteritis is presented. At laparotomy 25 perforations involving the distal jejunum and the entire ileum were noted with extensive peritoneal soilage. The perforations were successfully closed in single layer using vicryl (polyglactin 910) sutures and the peritoneum thoroughly lavaged. The patient has been followed up for thirty months with only minimal complications. We believe that single layer closure of extensive multiple typhoid perforations in a poor risk patient when weighed against resection and anastomosis with the possibility of short bowel syndrome is safer, quicker and more effective as long as the procedure is undertaken after adequate resuscitation and under appropriate antibiotic cover.
Fifty-six patients with displaced malleolar fractures had open reduction and fixation of the fracture fragments using, by random selection, either biodegradable implants or metal AO plates and screws. The cylindrical biodegradable implants were made of polylactide-glycolide copolymer (polyglactin 910). The complications, radiographic results and functional recovery were studied prospectively. After follow-up of at least one year, no significant differences emerged in the complication rate or in the results of treatment between the two methods of fixation. Because of the advantage of avoiding the need to remove metal fixation after union, we now use biodegradable internal fixation routinely to treat displaced malleolar fractures.
An experimental study of the behavior of the absorbable suture Polyglactin 910 (Vicryl) 0,2 metric in the tissue was performed. Microsurgical sutures of nerves and vessels (sciatic nerve and carotid artery) were performed and compared with a non-absorbable suture (Ethilon). The micromorphological studies included a period of 12 weeks after surgery. The absorbable suture showed equal mechanical qualities, with the advantage that the suture material and the tissue reaction disappeared after the 10th week, while the poor visualization of the absorbable suture under the operating microscope was a disadvantage.