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[Esthetic suture of the lower limbs after a saphenous vein graft in cardiac surgery. Polydioxanone vs Vicryl].

The vena saphena magna is widely used as a passage during myocardial revascularisation surgery (CABG). The preparation of the vein involves a long incision on the thigh and leg which is routinely closed using a continuous suture thread in Vicryl of the subcutis and continuous intradermal suture of the cutis. The authors retrospectively evaluated the functional and esthetic results of intradermal suture performed using two different types of reabsorbable thread: PDS II and Vicryl. A total of 178 patients underwent CABG surgery at the Heart Surgery Division of Tor Vergata University of Rome during the period January-September 1992. Mean age was 63 year +/- 7 (SD), 140 were males and 38 females. PDS II 3/0 was used for intradermal suture in 88 patients, whereas Vicryl 3/0 was used in 90. There were no significant differences between the two groups with regard to age, sex, number of grafts, associated pathologies or wound length. After 1-9 months (mean 5.6 months) the surgical wound on the saphenectomized limb was evaluated. It was found that compared to Vicryl the use of PDS II presented a higher incidence of keloids (p > 0.05). This was probably due to the greater reaction provoked in the dermis by the monofilament compared to twisted thread. The authors conclude that the use of a reabsorbable twisted thread, such as Vicryl or Vicryl Rapid, is preferable owing to the higher rate of compliance and lower incidence of complications.

Aged↗

[Laparotomy closure with continuous polydioxanone sutures].

The authors describe the method of closure of laparotomic wounds by means of an atraumatic continuous PDS loop suture. Based on evaluation of a group of 166 patients they appreciate the positive aspects of the technique of this suture, in particular the speed, easy implementation and safe closure of laparotomy. As regard the sewing material, they value highly the quality of atraumatic fibres which are firm and do not irritate the tissues.

Dioxanes↗

Absorbable sutures in tendon repair. A comparison of PDS with prolene in rabbit tendon repair.

The risks of foreign implantation may be avoided in tendon repair by the use of absorbable sutures, for example polydioxanone. In this study, the in vivo tensile strength half-life of 4/0 polydioxanone was found to be approximately 4 weeks. Using a rabbit model, we compared polydioxanone tendon repairs with polypropylene tendon repairs. Unilateral flexor digitorum longus repairs were performed on 46 rabbits using either polydioxanone or polypropylene. Tendons were harvested at 3 days, 2 weeks and 4 weeks and the tensile breaking strengths were obtained. 30 intact rabbit flexor digitorum longus tendons and 20 freshly repaired tendons were also tested. By 4 weeks, the repair strength had increased eight-fold from approximately 20 N to 166 N. The sutures made little contribution to the overall strength of a 4-week-old repair. There was no significant difference between polydioxanone and polypropylene repairs at any stage. These results show that polydioxanone repairs were as strong as polypropylene during the first critical weeks of tendon healing.

Absorption↗

Incisional hernia after laparotomy: prospective randomized comparison between early-absorbable and late-absorbable suture materials.

Incisional hernia is a serious postoperative complication of laparotomy. Selecting an appropriate suture material may lessen such morbidity. This study undertook a prospective, randomized comparison of early-absorbable polyglactin 910 suture versus late-absorbable polydioxanone loop suture for fascial closure after abdominal surgery. A series of 340 consecutive patients undergoing elective laparotomy were randomized to have fascial closure with either polyglactin 910 suture or polydioxanone loop suture between October 1993 and August 1996. A 2-year follow-up revealed that 23 patients had died, and the overall mortality rate was 6.8% (23/340). Ten (10/340, 2.9%) patients, including seven with polyglactin 910 suture and three with polydioxanone loop suture, developed incisional hernias. The early postoperative evaluation revealed an incidence of wound infection of 4.1% (14/340). The development of incisional hernia was not secondary to postoperative wound infection in this study. Among these 340 patients, 192 had malignant diseases and 148 had nonmalignant ones. Fascial closure with polyglactin 910 suture was associated with more incisional hernias than that with polydioxanone loop suture, with marginal significance for patients in the malignant group (4.7% versus 0%, p = 0.07) but not in the nonmalignant group (2.6% versus 4.2%, p = 0.67). In conclusion, abdominal closure with a late-absorbable polydioxanone loop suture may be beneficial to patients with a malignant disease for preventing incisional hernia.

Abdomen↗

Histologic reaction to four synthetic microsutures in the rabbit.

Histologic reaction to nylon, polypropylene, polyglactin-910, and polydioxanone microsutures was assessed in the uterine horn of the rabbit. At 24 days after insertion of the microsuture, a marked infiltration of histiocytes was seen around the nylon, polypropylene, and polydioxanone microsutures, whereas the reaction to polyglactin-910 was characterized by the presence of giant cells. At 80 days after insertion of the microsutures, the polydioxanone was almost entirely absorbed and the reaction to polyglactin-910 was minimal. Moderate histiocytic infiltration persisted around the nylon and polypropylene sutures. Fibrosis was also detected around the nylon and polypropylene sutures at 80 days, but not at all around the polydioxanone and polyglactin-910 sutures. We conclude that polydioxanone leaves little or no tissue reaction at 80 days in the uterine horn of the rabbit.

Animals↗

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↗

In vivo and in vitro degradation of monofilament absorbable sutures, PDS and Maxon.

Two new absorbable monofilament suture materials polydioxanone and Maxon are being employed increasingly in abdominal surgery because of increased strength retention and decreased tissue reactivity compared with previously available materials. As part of our investigation of the behaviour of suture materials, 3-0 sutures of polydioxanone and Maxon were enclosed in nylon pouches, a technique developed for in vivo experiments to prevent cellular interaction with implanted devices. The pouched sutures were gas sterilized, then implanted in either the extrafascial space or peritoneal cavity for periods of 1-5 wk. Sterilized sutures were also incubated in Ringer's lactate at 37 degrees C. Tensile strength of the exposed sutures was measured. For a given suture material and duration of incubation, there was no significant difference in tensile strength degradation among the three test environments. Although the strength of unexposed Maxon is greater than that of polydioxanone, the residual strength of Maxon decreases more rapidly in use, so that, after 2 wk, the strength of polydioxanone is greater. Scanning electron microscope examination of the suture surfaces reveals that polydioxanone develops surface crazing with time, whereas the surface morphology of Maxon remains relatively unaltered.

Animals↗