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PubMed1990

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↗

PubMed1990

Experimental and early clinical evaluation of vascular anastomoses with argon laser fusion and the use of absorbable guy sutures: a preliminary report.

This study investigated the feasibility of forming vascular anastomoses by use of argon laser tissue fusion and absorbable, monofilament polydimethylsiloxane guy sutures. In initial animal studies femoral arteriovenous fistulas approximately 1.5 cm in length were created bilaterally in each of 10 dogs and were studied histologically at 2, 4, 8, 16, and 24 weeks (two animals in each interval). In each animal, one anastomosis (control) was formed with continuous 6-0 polypropylene suture, and the contralateral anastomosis (experimental) was performed with an argon laser (0.5 watt, 5 to 7 minutes exposure, energy fluence 1100 to 1500 joules/cm2 per 1 cm length) with stay sutures of 5-0 polydimethylsiloxane at 0.5 to 0.65 cm intervals. At removal, all anastomoses were patent without hematomas, aneurysms, or luminal narrowing. Histologic examination at 2 to 16 weeks demonstrated resorption of the biodegradable suture material by a local inflammatory reaction. By 24 weeks, laser-fused specimens had no evidence of suture material at the anastomotic line, and healing consisted of a bond between artery and vein wall tissues. Control suture specimens at the same intervals exhibited an organized fibrous tissue response to the suture. Clinical adaptability of this technology has subsequently been evaluated in five patients at 10 to 27 months (21.6 +/- 5.8) by physical examination and duplex scanning and demonstrate no evidence of abnormal healing. This study establishes the experimental and preliminary clinical feasibility of laser-fused anastomoses aligned by biodegradable guy sutures and supports further investigation and refinement of the technique.

Adult↗

PubMedDate not supplied

Simultaneous and sequential selective suture removal to reduce astigmatism after penetrating keratoplasty.

We studied two separate groups of consecutive eyes with penetrating keratoplasty in avascular corneas in which we performed selective interrupted suture removal to decrease postoperative astigmatism, describing the time course of change in astigmatism. In the first group (29 eyes), multiple interrupted sutures were selectively removed at a single visit in an attempt to reduce the astigmatism to less than or equal to 3 diopters; the patients were followed for 30 months. In the second group (24 eyes), one interrupted suture was removed at each visit every 2 weeks until the astigmatism was less than or equal to 3 D; the patients were followed for 15 months. Surgical techniques were different in the two groups. Both techniques reduced postoperative astigmatism. Larger changes in astigmatism occurred between the first suture removal visit and the subsequent visit in the first group. At 1 year, the multiple-suture-removal-at-a-single-visit group averaged 3.1 D of astigmatism, with 50% of eyes less than or equal to 3 D, whereas the single-suture-removal-at-multiple-visits group had a mean astigmatism of 1.9 D with 88% of eyes less than or equal to 3 D. The two groups we studied were not directly comparable, because surgical techniques differed, because they were operated at different times, and because the cases were not randomized. Nevertheless, we think that selective suture removal to reduce astigmatism after penetrating keratoplasty is best done by removing only one (or sometimes two) sutures per examination.

Astigmatism↗

PubMed1979

[Reaction of the fibrose eyeball covering upon the suture material synthetic and absorbable "Dexon". (Experimental study) (author's transl)].

The present paper deals with the results of 20 eyes of experimentally operated laboratory animals, whose perforating wounds (of cornea and those of sclerocorneal region) have been suturated with a new type of absorbable synthetic suture material "Dexon" thickness being 6-0. The synthetic absorbable suture material "Dexon" is made of polyglycol acid, and it has been introduced to market by the firm Davis and Geck (U.S.A.). The inflammatory tissue reaction to the presence of the suture material "Dexon" is prominent and can by compared to the reaction to chromic resorbable suture materials (catgut or collagen). The suture material "Dexon" start to resorb in the course of the 2nd-3rd weeks after operation. The suture material "Dexon" can be used at an advantage in the operation where it is possible to cover the knots by a conjuctival lobe (in sclerocorneal region or in strabismus surgery) in this way the tendency to overgrowing of epithelial cells along the suture channels can be prevented. The "Dexon" material is sufficiently flexible and firm and has no antigenic properties, therefore it appears very prospective for ophthalmosurgery.

Animals↗

PubMed1987

[Microsurgical suture and fibrin gluing of nerve anastomoses. Animal experiment study using Cohn I human plasma fraction].

In a comparison of suture and fibrin bonding (using human plasma fraction Cohn I) direct as well as autologous and homologous nerve transplantations were performed in animal experiments. The study was carried out in a total of 66 Nn. ischiadici in Albino Wistar rats. With and without transplants the anastomoses were provided 26 times with the usual microsurgical single-button suture technique and 11 times tith a fibrin adhesive cuff with sequential application of the two components (500 I. U. thrombin/ml, 3,000 units contrycal) or simultaneous application after premixing of the components (5 I. U. thrombin/ml, 50 units contrycal). The qualitative evaluation was carried out after 4, 6, and 12 weeks according to the clinical and histological findings. With the use of sufficiently long transplants the nerve anastomoses could be fixed sutureless with the adhesive cuff more simply than with sutures. Histologically an undisturbed growing forth of the axons without foreign-body reactions and scarred constrictions could be proved. The sutured anastomoses, too, showed a good regeneration; owing to the 2-3 single button-sutures only low-degree tissue reactions occurred around the threads without any greater impairment of the proliferation of the neurites. In case of the direct uniting of the nerves adhesion was only possible in combination with a holding suture. In most cases, however, anastomose dehiscences with a bad result were nevertheless found. The direct nerve suture had to be carried out with 5-7 single-button sutures. In this case, considerably pronounced foreign-body reactions were sometimes found histologically. The nerve regeneration, however, was much better than in case of bonding by adhesion. In contrast to the application in direct nerve joining, the Cohn I adhesive could be used with good results for nerve transplantations.

Anastomosis, Surgical↗

PubMedDate not supplied

In vitro adherence of bacteria to sutures in cardiac surgery.

The adherence of bacteria to sutures used in cardiac surgery was studied by in vitro quantitative determination with [3H]-leucine-labeled Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus sanguis. The adherence per unit area for staphylococci was least for monofilament polypropylene (Prolene), 3 times higher (p less than 0.05) for braided polyester (Mersiline) and greatest (10 times, p less than 0.005) for braided polyester sutures coated with polybutylate (Ethibond). Mean values for the adherence of streptococci were low for all the sutures. Sutures pretreated with human plasma showed a 12-37% increase in bacterial adherence. The cell surface hydrophobicity, surface charge and the haemagglutinating property of bacteria did not correlate with their adherence property. In view of these observations, it is suggested that: (a) the preferential adherence of staphylococci to intra-cardiac sutures may be one of the explanations for its being the commonest cause of early prosthetic valve endocarditis, (b) there is a need for a careful selection of sutures used in cardiac surgery and (c) the described in vitro assay for bacterial adherence may be used for monitoring the development of better designed sutures and the effect of incorporation of antibiotics in the sutures.

Bacterial Adhesion↗

PubMed1989

[The role of suture material on healing of vascular anastomosis].

The effect of suture material on healing of vascular anastomosis was examined. Four types of vascular grafts, i.e., autogenous vein, preserved human umbilical cord vein, expanded polytetrafluoroethylene and double velour knitted Dacron, were implanted into the abdominal aorta of 78 adult mongrel dogs using two kinds of absorbable sutures (multifilament polyglycolic acid: PGA and monofilament polydioxanone: PDS) and a nonabsorbable suture (polypropylene: PP). The macroscopic findings and the histologic examinations showed that hyalinoid degeneration and calcification resulting from tissue ischemia due to tight and long lasting suture loops interfered with tissue healing at the PP-anastomotic site. On the other hand, fairly good healing of the anastomoses was observed with absorbable sutures because of the reduction of ischemia. The absorbable suture-anastomoses could tolerate systemic blood pressure within one month after implantation, and there was no anastomotic disruption at 1000 mmHg pressure in the bursting test 12 months after grafting. From Dec., 1984, 55 anastomoses in 34 bypass-operations employing autogenous vein grafts were performed using PGA and PDS in 28 cases clinically. There were no anastomotic complications. In conclusion, the synthetic absorbable suture material, especially in the form of monofilament, seems to be most suitable for suturing or anastomosing autogenous small vessels at present.

Absorption↗

PubMed1989

Nonabsorbable suture material in corneoscleral sections--a comparison of novafil and nylon.

We compared a newly available nonabsorbable monofilament ophthalmic suture, 9/0 Novafil (Davis & Geck), with 10/0 nylon (Alcon), currently the most popular suture for closure of corneoscleral sections. Surgery was performed on nine rats and ten rabbits. In each case a 120 degrees corneoscleral section was made in each eye and closed with interrupted sutures of 9/0 Novafil in one eye and 10/0 nylon in the other. We compared their handling qualities during surgery, as well as their effect on postoperative wound inflammation. In addition we examined the suture material from each eye of the rats by scanning electron microscopy (SEM) after 3 months, and we compared the surgically induced astigmatism in the rabbits in the two suture groups. Both suture materials were easy to handle and well tolerated. Nylon sutures from six of the eight rat eyes studied showed SEM evidence of surface disintegration after 3 months, whereas all the Novafil sutures remained intact.

Absorption↗

PubMed1988

[Experimental comparison of Maxon and chromic catgut in suturing of the urinary bladder].

The new monofile absorbable suture material Maxon was compared with Chromic catgut in bladder suturing in rabbits. Comparisons were made after 1, 2, 4, 8 and 12 weeks. The rate of stone formation was mainly determined by the suture technique used and not so much by the suture material. This was demonstrated by the low number of stones formed after using extramucosal suturing technique. Once a suture, be it Maxon or Chromic catgut, comes in contact with urine, concrements may form and the new monofile properties of Maxon do not offer any advantages here. On the other hand, Maxon does not enhance stone formation either. E. coli or Proteus infections did not influence formation of stones. The histological examinations showed Maxon to cause fewer inflammatory reactions. Sutures with Chromic catgut caused inflammation of the bladder wall, subsiding after 4 weeks. An existing urinary infection did not appear to influence the inflammatory process. Maxon offers an advantage over Chromic catgut in extramucosal sutures causing fewer inflammatory reactions.

Animals↗

PubMed1988

Functional suture-holding layer of the esophagus in the dog.

Several investigators have stated that the suture-holding layer of the esophagus is the mucosa. In this study, the component layers of the esophagus were separated. Segments of the cervical esophageal wall, muscularis, submucosa, and submucosa-mucosa were each sutured, and the suture lines were subjected to tensile forces. When subjected to tensile force, all suture lines failed when sutures pulled through the tissue. The data were subjected to statistical analysis. Based on this analysis, it was concluded that the full esophageal wall had the greatest ability, and the muscularis the least ability, to hold sutures against tension. Therefore, when no significant difference in suture-holding ability between the submucosa alone and the submucosa-mucosa together was demonstrated, it was concluded that the submucosa was the suture-holding layer of the esophagus.

Animals↗

PubMed1977

Synthetic absorable sutures.

Based on the many reports published in the past several years, the synthetic absorbable sutures have been recognized as an important step forward in the history of suture materials. Synthetic absorbable sutures have been approved by the Food and Drug Administration for almost all surgical uses with the exception of certain cardiovascular and neurologic surgical procedures in which nonabsorbable sutures are mandatory, as, for example, in the suturing of a prosthesis to tissue. They have been used in many thousands of surgical operations of many types and show prospects of replacing other absorbable suture materials traditionally used in surgical operations. Moreover, because of their retained strength and low tissue reactivity, the synthetic absorbable materials are being used in some procedures in place of nonabsorbable materials. Thus, instead of using several different suture materials during some operations, the surgeon may find himself using one synthetic absorbable suture in different sizes for an entire procedure.

Abdomen↗

PubMed1986

[Animal experiment studies of combined suture and glue microanastomoses using a fibrin glue based on the Cohn I human plasma fraction].

A total of 48 end-to-side microvascular anastomoses between the A. and the V. femoralis of Albino Wistar rats were established with and without an additional gluing using the human plasma fraction Cohn I (Cohn-I adhesive) and clinically and histologically examined after 3-4 weeks--group 1 with 4 single button sutures and gluing, group 2 with 8 single button sutures and gluing as well as a control group with the usual suture technique with 12-14 single knob sutures (in each case 16 anastomoses). The time required for anastomosing could not be considerably reduced by the suture-gluing technique. In group 1 the thrombotic occlusion due to vascular wall dehiscences with penetration of the adhesive material into the lumen could not be prevented in eight anastomoses. Owing to the exact vascular wall adaptation with 8 single button (group 2) 14 anastomoses were free just as in the control group. Histologically the tissue-preserving influence of the gluing could be confirmed by the reduction of the number of sutures. Summarising it can be said that the perfectly performed suture technique should continue to play the dominating role, but that the combined suture-gluing technique can be a great help for the surgeon in special cases.

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↗

PubMed1983

Studies on the efficacy and safety of polydioxanone monofilament absorbable suture.

Preclinical animal studies have clearly indicated that dyed and undyed polydioxanone monofilament absorbable sutures have prolonged breaking strength retention, a reliable absorption profile and minimal tissue reaction. The suture provides wound support throughout extended postoperative periods and is most useful in those situations in which prolonged suture integrity is desirable. Based upon these clinical studies, polydioxanone monofilament absorbable sutures must be considered as a reliable, easy to use suture material which fulfills all performance criteria. The over-all clinical results were excellent. Polydioxanone was rated as significantly superior to gut in every category evaluated. The results of this study support the claim that polydioxanone monofilament absorbable sutures are the suture of choice for general surgical use as well as in a variety of other clinical applications in which an absorbable suture is required.

Absorption↗

PubMed1983

[Polydioxanon (PDS)--a new monofilar synthetic, absorbable suture material. Tensile strength studies in a controlled clinical trial on the large intestine of humans and physical parameters in in vitro tests].

We investigated the properties of tensile strength for the following suture materials: Polyglycolic acid (2. and 3.generation), Polyglactin 910 (3.generation) and Polydioxanon. They were situated within human large bowels for 10 to 12 days and investigated in a controlled experimental procedure. The decrease of the tensile strength in the human large bowel is significantly slower for polydioxanon suture (PDS) than for PGA (2. and 3.generation) and Polyglactin 910 (3.generation) suture. As PDS-suture are primarily less tractable than the others, there is no significant difference of tractability between all sutures after 11 days of implantation within the human colon. For PGA (3.generation) and Polyglactin 910 we found a strong loss of tractability after 10 to 12 days. In a second experimental series tensile strength, knot breaking security and knot holding capacity were tested in a tensiometer for absorbable suture materials with 3 and 6 parallel knots. The tensile strength was higher than the knot security for all sutures. Coated suture material (PGA and Polyglactin 910, both 3.generation) as well as the new monofile polydioxanon must be knotted manyfold for a secure knot position.

Adult↗

PubMed1983

Staplers, two- and one-layer manual suturing in gastrointestinal surgery--a retrospective study of 553 patients.

The case histories of all patients with gastrointestinal suturing in a six-year period were studied retrospectively. Anastomoses of the oesophagus, left colon and rectum were always checked radiologically 7-14 days after operation. Suture-line dehiscence, bleeding and stricture formation were seen in 18 cases (= 8.9%) out of 202 patients with stapled suturing, 15 cases (= 7.8%) out of 192 patients with two-layer manual suturing, and 4 cases (= 2.5%) out of 159 patients with one-layer seromuscular manual suturing. After excluding the patients with a pyloroplasty, the adverse factors were comparable in these groups of patients. The suture-line complication rate after one-layer manual suturing (2.5%) proved to be significantly lower than with stapled suturing (9.6%). Reduction in operating time by using the staplers proved to be minimal. The use of staplers is expensive and is not often indicated.

Cost-Benefit Analysis↗

PubMed1981

Polydioxanone (PDS), a novel monofilament synthetic absorbable suture.

The chemical and biologic properties of a unique, new monofilament suture, polydioxanone, have been described. The inherent flexibility of its polymer allows the polydioxanone suture to be fabricated into a monofilament fiber useful for all sizes of sutures. Polydioxanone suture has greater pliability than polypropylene suture and has greater strength than that of other monofilament sutures. In the body, polydioxanone suture retains its strength for longer periods than other synthetic absorbable sutures--58 per cent versus 1 to 5 per cent at four weeks and 14 per cent versus zero per cent at eight weeks, respectively. It elicits a low order of tissue response and is absorbed by simple hydrolysis.

Absorption↗

PubMed1982

Suture resistance to infection.

The emergence of both absorbable and nonabsorbable synthetic materials has been primary among the many new developments in suture materials. This is a study of 16 types of natural and synthetic suture materials and their resistance to both gram-positive and gram-negative infections. Four hundred and twenty suture inplants were made in the Edlich mouse model. The 16 different sutures were compared to appropriate controls and graded by the degree of infectibility. Synthetic sutures were superior in all areas. The monofilament sutures performed better than the multifilament sutures. Lubricating coatings had no effect on infectibility. Natural sutures performed poorly and should not be used in wounds that are potentially susceptible to infection.

Animals↗