关节镜下薇乔抗菌缝线内固定治疗髌骨中下极粉碎性骨折

目的探讨关节镜下薇乔抗菌缝线内固定治疗髌骨中下极粉碎性骨折的疗效。方法手术治疗40例髌骨下粉碎性骨折患者,20例行克氏针改良张力带固定术(改良张力带组),20例采用关节镜下薇乔抗菌缝线内固定术(薇乔抗菌缝线组),比较两组术中、术后及功能情况。结果改良张力带组比薇乔抗菌缝线组手术出血量多、手术时间与住院时间长,差异均有统计学意义(P0.05)。完全负重时间两组差异无统计学意义(P0.05)。患者均获得随访,时间6~12个月。患肢功能恢复情况:改良张力带组优13例,良5例,可1例,差1例;薇乔抗菌缝线组优17例,良3例,两组优良率差异有统计学意义(P0.05)。并发症:改良张力带组切口裂开、感染1例,薇乔抗菌缝线组无并发症发生。结论关节镜下薇乔抗菌缝线内固定治疗髌骨中下极粉碎性骨折疗效更好,创伤小,操作简便,无需二次手术。     

三种不同缝合线对腹壁手术切口愈合质量影响的研究

目的探讨不同手术缝合线对腹部手术切口愈合质量的影响,为促进腹壁手术切口的愈合提供新的理论依据。方法将2013年6月至2015年6月川北医学院附属医院普通外科收治的341例行开腹手术患者按时间表随机分组方法随机分为3组,即聚对二氧环己酮Ⅱ缝合线(polydioxanonⅡsuture,PDSⅡ缝合线)组,采用PDSⅡ缝合线全筋膜层连续缝合腹壁切口;薇乔线组,采用抗菌薇乔线全筋膜层连续缝合腹壁切口;普通丝线组,采用普通丝线分层间断缝合腹壁切口。比较3组患者切口愈合质量。结果对于缝合时间而言,PDSⅡ缝合线组为(11.23±1.62)min,短于薇乔线组的(14.04±1.20)min,其差异具有统计学意义(P0.05),且上述2组的缝合时间均短于普通丝线组的(21.95±1.95)min,差异具有统计学意义(P0.05)。在排异反应、切口感染和切口裂开发生率方面,PDSⅡ缝合线组和薇乔线组均较普通丝线组低,差异均具有统计学意义(P0.05),而PDSⅡ缝合线组与薇乔线组相比,差异则不具有统计学意义(P0.05)。在术后住院时间和切口脂肪液化、积液方面,3组间相比差异均无统计学意义(P0.05)。结论 PDSⅡ缝合线和抗菌薇乔线全筋膜层连续缝合腹壁切口可明显缩短缝合时间,降低术后切口排异反应、切口感染和切口裂开的发生率,有助于患者术后快速康复。     

可吸收倒刺缝合线在人工全膝关节置换术中应用的病例对照研究

目的 :对比使用倒刺缝合线和传统缝线在人工全膝关节置换术中切口关闭的临床应用效果。方法 :自2013年9月至2014年6月,选取膝骨性关节炎患者116例,分为研究组(T)和对照组(C)。研究组68例,平均年龄(65.26±8.50)岁,其中女58例,男10例;对照组48例,平均年龄(64.43±10.08)岁,其中女41例,男7例。所有患者接受单侧初次人工全膝关节置换术。研究组选用可吸收倒刺缝合线连续缝合关节囊,对照组选用可吸收抗菌薇乔连续锁边缝合关闭关节囊。所有患者采用2-0可吸收抗菌薇乔缝合皮下组织,皮钉闭合皮肤。对两组患者的缝合时间、术后3 d切口并发症、术后住院时间及术后特殊事件进行统计比较。结果 :研究组平均缝合时间(21.65±4.11)min(15~32 min),对照组平均缝合时间(31.83±4.55)min(22~45 min),研究组低于对照组(P=0.000);切口相关并发症发生率研究组30.88%(21/68),对照组20.83%(10/48),两组差异无统计学意义(χ2=1.451,P=0.161);研究组术后平均住院时间(5.68±1.36)d,对照组(5.46±1.29)d,两组差异无统计学意义(P=0.407)。结论 :使用倒刺缝合线应用于人工全膝关节置换术,能够明显缩短手术缝合时间,但需要更为细致的缝合方法和谨慎的术后观察。切口并发症的发生对手术效果及患者住院时间无明显影响。     

Quill缝线在腹腔镜下子宫肌瘤剔除术中的应用效果

目的探讨Quill缝线在腹腔镜下子宫肌瘤剔除术中的应用效果。方法 2012年3~6月我院103例大子宫肌瘤(直径8~12 cm)在腹腔镜下行子宫肌瘤剔除术,52例应用Quill缝线缝合子宫肌瘤残腔(Quill线组),51例应用薇乔线缝合肌瘤残腔(薇乔线组),比较2组患者术中、术后情况及预后。结果 Quill线组缝合子宫时间(8.7±1.9)min,明显短于薇乔线组(17.4±3.2)min(t=-16.815,P=0.000);Quill线组手术时间(77.2±8.2)min,明显短于薇乔线组(91.8±14.0)min(t=-6.473,P=0.000);Quill线组留置盆腔引流时间(28.0±3.9)h,明显短于薇乔线组(41.1±7.1)h(t=-11.636,P=0.000);Quill线组术中出血量(88.4±11.6)ml,明显少于薇乔线组(112.9±20.9)ml(t=-7.374,P=0.000);Quill线组术后病率11.5%(6/52),明显低于薇乔线组27.4%(14/51)(χ2=4.167,P=0.041);Quill线组术后住院时间(3.5±0.5)d,明显短于薇乔线组(3.8±0.6)d,(t=-2.759,P=0.007)。术后随访2年:2组术后1、2年子宫肌瘤复发率和妊娠率比较差异均无统计学意义(P0.05)。结论腹腔镜下子宫肌瘤剔除术中应用Quill缝线缝合肌瘤残腔可以降低手术难度,明显减少术中出血量,缩短缝合时间,有利于患者术后恢复,尤其适用于大子宫肌瘤(8~12 cm)缝合残腔,值得推广应用。     

碘伏联合贝复济预防急诊腹部污染手术后切口感染的疗效观察

目的观察碘伏联合贝复济预防急诊腹部污染手术后切口感染的临床疗效。方法临床纳入急诊腹部切口污染手术患者76例,根据切口消毒剂的不同分为2组,每组38例。对照组给予2%碘酊与75%酒精消毒;观察组给予0.25%碘伏联合贝复济消毒。观察2组患者切口愈合情况与感染情况。结果观察组切口甲级愈合率高于对照组,切口感染率低于对照组;切口愈合时间、换药次数均优于对照组。2组比较,差异均有统计学意义(P0.05)。结论对急诊腹部污染手术切口使用碘伏联合贝复济消毒,能提高切口愈合率并降低感染率,并缩短切口愈合时间,减少换药次数。     

快速康复外科在胃肠外伤中的应用

目的探讨在急诊胃肠外伤中采用快速康复外科(FTS)的安全性、可行性及有效性。方法回顾性选择2007年7月至2013年7月期间武冈市人民医院普外科收治的符合纳入和排除标准的61例行胃肠外伤修补术患者的临床资料,2007年7月至2010年7月期间收治的胃肠外伤患者作为对照组(n=32),2010年7月至2013年7月期间收治的胃肠外伤患者作为FTS组(n=29),比较2组患者术后胃肠功能恢复时间、住院时间、伤口感染、肺部感染及死亡情况。结果 FTS组的平均胃肠功能恢复时间(2.21 d比3.16 d,P=0.000)和住院时间(7.45 d比9.78 d,P=0.000)均明显短于对照组,FTS组的肺部感染率明显低于对照组〔3.4%(1/29)比21.9%(7/32),P=0.033〕,2组伤口感染率〔3.4%(1/29)比15.6%(5/32),P=0.111〕和死亡率〔0(0/29)比3.1%(1/32),P=0.337〕比较差异无统计学意义。结论 FTS应用于那些就诊及时且受伤局限的胃肠外伤患者的治疗是安全、有效的,可促进术后胃肠功能恢复,缩短住院时间,并不增加术后并发症率及死亡率。     

超重的穿孔或坏疽性阑尾炎患者行腹腔镜手术的近期疗效分析

目的探讨腹腔镜手术在超重或肥胖(以下统称"超重")的穿孔或坏疽性阑尾炎患者中应用的安全性及近期疗效。方法回顾性分析我院2007年1月至2014年12月期间急性穿孔性或坏疽性阑尾炎接受腹腔镜手术(152例)和开腹手术(60例)患者的临床资料,根据身体质量指数(BMI)将患者分为超重组(BMI≥25 kg/m2,n=69)和正常体重组(BMI25 kg/m2,n=143),观察指标包括中转率、手术时间、住院时间、再住院率、再手术率、总并发症及各种具体并发症发生率。结果 1超重组和正常体重组行腹腔镜的中转开腹率比较差异无统计学意义〔4.2%(2/48)比6.7%(7/104),χ2=0.06,P0.05〕。2超重组行腹腔镜的手术时间明显短于超重组行开腹者〔(41.6±11.7)min比(63.1±23.3)min,P0.01〕,超重组行腹腔镜与正常体重组行腹腔镜比较差异无统计学意义〔(41.6±11.7)min比(39.6±12.7)min,P0.05〕。3超重组行腹腔镜手术的总并发症率及切口感染率均明显低于超重组行开腹手术者〔总并发症率:16.7%(8/48)比52.4%(11/21),χ2=9.34,P0.01;切口感染率:4.2%(2/48)比33.3%(7/21),χ2=8.54,P0.01〕。尽管超重组(腹腔镜和开腹)的总并发症率较正常体重组(腹腔镜和开腹)明显增加〔27.5%(19/69)比14.7%(21/143),χ2=5.02,P0.01〕,但超重组行腹腔镜与正常体重组行腹腔镜比较差异并无统计学意义〔16.7%(8/48)比12.5%(13/104),χ2=0.45,P0.05〕。4所有行腹腔镜患者(超重和正常体重)的再手术率明显低于所有行开腹手术患者〔1.3%(2/152)比10.0%(6/60),χ2=6.7,P0.01〕。5无论超重或正常体重患者行何种手术的腹腔内残余脓肿发生率、肺部感染率及住院时间比较差异均无统计学意义(P0.05)。结论对于罹患穿孔性或坏疽性阑尾炎的超重患者,腹腔镜手术是较开腹手术更安全、有效的手术方式,与正常体重的穿孔性或坏疽性阑尾炎患者比较,超重状态并不显著增加腹腔镜手术的手术难度及围手术期风险。     

“快薇乔”缝线缝合手术切口368例分析

自1997年3月至12月,对我院施行妇产科手术的368例患者,采用“快薇乔”可吸收性合成缝线行手术切口皮内连续缝合法,效果良好,分析如下: 资料与方法 1.一般资料 368例患者,剖宫产194例(无论腹部纵切口或横切口),腹式宫全切16例,附件切除28例,产时会阴侧切手术130例,病人年龄、营养状况及手术指征与同期传统方法缝合者无差异,术后常规应用抗生素预防感染。 2.缝合方法 腹部手术238例,关腹时常规步骤缝合腹膜、腹直肌前鞘及皮下组织后,采用强生医疗器械公司生产的4/0“快薇乔”消毒可吸收性合成缝线自切口一侧皮内顶端连续     

大隐静脉高位结扎加剥脱术中两种皮肤缝线的效果比较

目的比较Prolene聚丙烯缝线与普通丝线用于原发性大隐静脉曲张患者大隐静脉高位结扎加剥脱术缝合皮肤的效果。方法纳入四川大学华西医院2015年1月1日至2015年12月31日期间入院且符合纳入标准的原发性大隐静脉曲张患者共83例,其中男27例,女56例;年龄30~63岁,平均46.7岁;CEAP分级C2级42例,C3级41例。将患者根据入院日期的顺序分为丝线组(奇数次序,n=38)和滑线组(偶数次序,n=45),丝线组采用1#慕丝线而滑线组采用Prolene 5-0聚丙烯缝线缝合皮肤。预定术后6个月随访患者的切口区色素、切口区色素宽度、缝线区色素、缝线区色素宽度、患者与观察者瘢痕评分,患者与观察者对切口的满意度评分。结果(1)2组患者的性别、年龄、体质量指数、随访时间及C2级患者和吸烟患者的比例比较差异均无统计学意义(P0.05)。(2)手术成功率为100%,所有手术切口均愈合良好,无切口感染,2组分别有2例患者术后第3天有1个切口皮下有少许血肿,予以换药处理后明显好转,所有患者均于术后14 d拆除缝线,均获得随访。(3)2组患者的切口区色素及切口区色素宽度比较差异均无统计学意义(P0.05),滑线组的缝线区色素及缝线区色素宽度均明显优于丝线组(P0.05)。(4)2组患者的观察者瘢痕评分及患者瘢痕评分评估结果比较差异均无统计学意义(P0.05),滑线组的观察者满意度评分和患者满意度评分均明显高于丝线组(P0.05)。结论 Prolene聚丙烯缝线较普通丝线用于大隐静脉曲张手术皮肤缝合的切口美观性有优越性,可以提高患者和观察者对切口的满意度。     

肠腔内外双套管负压引流在左半结肠癌并急性梗阻一期切除吻合中的应用

目的探讨肠腔内外双套管负压引流在左半结肠癌并急性梗阻一期切除吻合中的可行性与安全性。方法前瞻性收集2009年1月至2012年12月期间笔者所在医院收治的81例左半结肠癌并急性梗阻患者,随机分为一期组(n=41)和对照组(n=40)。一期组在肠腔内外双套管负压引流、全结肠灌洗及小肠减压的条件下行急诊一期切除吻合,对照组行传统分期手术,比较2组患者的手术时间、术中出血量、术后排气时间,住院时间、住院费用及吻合口漏等手术并发症的差异。结果一期组和对照组患者的手术时间〔(166±19)min比(173±23)min〕、术中出血量〔(253±42)m L比(273±50)m L〕及术后排气时间〔(3.24±0.73)d比(3.50±0.95)d〕比较差异均无统计学意义(P>0.05),但一期组的住院时间〔(15.1±2.3)d比(23.1±4.1)d〕和住院费用〔(3.70±0.68)万元比(5.77±0.95)万元〕均短于(少于)对照组(P<0.05)。在并发症方面,一期组和对照组患者的伤口感染〔7.3%(3/41)比10.0%(4/40)〕、盆腹腔感染〔4.9%(2/41)比10.0%(4/10)〕、肺部感染〔12.2%(5/41)比15.0%(6/40)〕及吻合口漏〔2.4%(1/41)比5.0%(2/40)〕发生率比较差异均无统计学意义(P>0.05)。术后所有患者均获访,随访时间为1~36个月,中位数为22个月。随访期间,2组患者的死亡率〔0(0/41)比2.5%(1/40)〕、复发率〔2.4%(1/41)比5.0%(2/40)〕及转移率〔7.3%(3/41)比10.0%(4/40)〕比较差异均无统计学意义(P>0.05)。结论在肠腔内外双套管负压引流、全结肠灌洗及小肠减压的条件下,左半结肠癌并急性梗阻行一期切除吻合是安全和可行的。     

A Study of the Efficacy of Antibacterial Sutures for Surgical Site Infection: A Retrospective Controlled Trial

To reduce bacterial adherence to surgical sutures, triclosan-coated polyglactin 910 suture materials with antiseptic activity were developed. The aim of this study was to evaluate whether the incidence of surgical site infections can be reduced when triclosan-coated sutures are used. Until December 2009, we used conventional polyglactin 910 sutures (VICRYL, Ethicon) for the closure of the fascia in digestive tract surgery. Therefore, for the control group we retrospectively collected surveillance data for 1.5 years. In the control group, 611 patients underwent digestive tract surgery with VICRYL sutures. Beginning in July 2010, we used triclosan-coated polyglactin 910 sutures (VICRYL Plus, Ethicon, Tokyo, Japan) for the closure of the fascia in all digestive surgeries. So, we collected data for the study group from July 2010 until June 2011. In the study group, 467 patients underwent digestive tract surgery with triclosan-coated VICRYL Plus sutures. In the control group, 75 patients (12.2%) developed wound infections. In the study group, 31 patients (6.6%) developed wound infections, which was significantly lower. Emergency cases; laparoscopic cases, including some cholecystectomy and colectomy cases; American Society of Anesthesiologists classification; the use of immunosuppressive therapy; colostomy cases; wound classification; and suture material were identified as the risk factors for wound infections. In both groups, as the wound classification worsened, the wound infection rate increased. Triclosan-coated polyglactin 910 antimicrobial sutures lead to a significant decrease in the incidence of surgical site infections, especially in clean/contaminated cases.     

Impact of using triclosan-antibacterial sutures on incidence of surgical site infection

Background

Surgical site infection is a common complication of surgery. Its morbidities range from delayed healing to systemic sepsis. It has impact on the economy and health care resources.

Methods

This study was a prospective, randomized, double-blinded, controlled multicenter study aimed to compare triclosan-coated polyglactin 910 sutures with polyglactin 910 sutures for the reduction of surgical site infections. This article details the results from the Cairo University center. A total of 450 patients who had undergone different surgical procedures were enrolled; 230 were enrolled in the study group and 220 were enrolled in the control group.

Results

The study group and the control group were comparable regarding risk factors for surgical site infection. Surgical site infection incidence was 7% in the study group and 15% in the control group (P = .011). The mean extended stay as a result of infection was 3.71 days, with an average cost $91 US per day.

Conclusions

Use of the triclosan-coated polyglactin 910 antimicrobial suture lead to reduction of surgical site infection and has an impact on saving health care resources. The triclosan-coated polyglactin 910 antimicrobial suture could save $1,517,727 yearly in this single center.     

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.     

Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL plus antibacterial suture (coated polyglactin 910 suture with triclosan) with coated VICRYL suture (coated polyglactin 910 suture)

BACKGROUND: Coated polyglactin 910 suture with triclosan was developed recently in order to imbue the parent suture, coated polyglactin 910, with antibacterial activity against the most common organisms that cause surgical site infections (SSI). Because such alterations could alter the physical properties of the suture, this study sought to compare the intraoperative handling and wound healing characteristics of coated polyglactin 910 suture with triclosan and traditional coated polyglactin 910 suture in pediatric patients undergoing various general surgical procedures. METHODS: This was a prospective, randomized, controlled, open-label, comparative, single-center study. Pediatric patients (age 1-18 years) undergoing various surgical procedures were randomized in a 2:1 ratio to treatment with either coated polyglactin 910 suture with triclosan or coated polyglactin 910 suture. The primary endpoint was the surgeon's assessment of the overall intraoperative handling of coated polyglactin 910 suture with triclosan and traditional coated polyglactin 910 suture without triclosan. The secondary endpoints included specific intraoperative suture handling measures and wound healing assessments. The suture handling measures were (1) ease of passage through tissue; (2) first-throw knot holding; (3) knot tie-down smoothness; (4) knot security; (5) surgical handling; (6) surgical hand; (7) memory; and (8) suture fraying. Assessment of wound healing included the following: Healing progress, infection, edema, erythema, skin temperature, seroma, suture sinus, and pain. Adverse events were recorded. RESULTS: Scores for intraoperative handling were favorable and not significantly different for both sutures, although coated polyglactin 910 suture with triclosan received more "excellent" scores (71% vs. 59%). Wound healing characteristics were comparable for both sutures except for pain on postoperative day 1. Significantly fewer patients treated with polyglactin 910 suture with triclosan reported pain on day 1 than patients who received the other suture (68% vs. 89%, p = 0.01). The overall incidence of adverse events was 18%; none was devicerelated. CONCLUSIONS: Coated polyglactin 910 suture with triclosan performed as well or better than traditional coated polyglactin 910 suture in pediatric patients undergoing general surgical procedures. The incidence of postoperative pain was significantly less in patients treated with coated polyglactin 910 suture with triclosan than the traditional suture. We speculate that polyglactin 910 suture with triclosan, by inhibiting bacterial colonization of the suture, reduced pain that can be an indicator of "subclinical" infection. Coated polyglactin 910 suture with triclosan may be a useful alternative in patients at increased risk of developing SSI.     

Experimental efficacy study of coated VICRYL plus antibacterial suture in guinea pigs challenged with Staphylococcus aureus

BACKGROUND: This study evaluated the ability of coated polyglactin 910 suture with triclosan (Coated VICRYL Plus Antibacterial) suture to inhibit the colonization of bacteria on the suture after direct in vivo inoculation challenge with Staphylococcus aureus utilizing a guinea pig model. METHODS: One control suture (4-5 cm) and one test suture (4-5 cm) were implanted subcutaneously in the dorsal-lateral regions (control on the left side, test on the right side, approximately 5 cm apart) in 16 female Hartley guinea pigs (300-400 g) via a 20-gauge catheter. Each implantation site was challenged directly with 2.1 x 10(4) colony forming units (cfu) of Staphylococcus aureus through the indwelling catheter. The test material was coated polyglactin 910 suture with triclosan (2-0, dyed), and the control material was coated polyglactin 910 suture (2-0, undyed). At 48 h, suture articles were explanted and a bacterial enumeration assay was performed. RESULTS: There was a significant difference (p < 0.05) in the number of bacteria recovered between the study groups at 48 h post-implantation. The mean recovery for test sutures was 559 cfu, and the mean recovery for control sutures was 16,831 cfu. Coated polyglactin 910 suture with triclosan provided a 30.5-fold (96.7%) reduction in the number of recovered bacteria compared to standard coated polyglactin 910 suture. CONCLUSIONS: This study demonstrates that coated polyglactin 910 suture with triclosan inhibits bacterial colonization of suture after direct in vivo challenge with S. aureus in a guinea pig model.     

Experiences with polyglactin 910 (Vicryl) in general surgery

The physical properties of polyglactin 910 (Vicryl) have been studied experimentally and clinically and compared with other synthetic and natural suture materials. Polyglactin 910 has a relatively high fluid absorption capacity but a low capillary capacity. The tensile strength is high and well comparable with, or superior, to other synthetic non-absorbable suture materials commonly used. The elongation at break is moderate. No unfavourable wound reaction to the suture material has been registered. The material has not increased the expected frequency of wound infections. The follow up of laparotomized patients 12-18 months after the operation showed a very low frequency of wound hernia. Neither was any recurrence noticed after repair of inguinal hernia. No clinical signs of leakage in the anastomoses of the gastrointestinal region was registrated. It is concluded that polyglactin 910 in a wide extent seems to be able to replace catgut and also non-absorbable suture materials when normal wound healing is to be expected.     

Irradiated Polyglactin 910 (Vicryl Rapide) for Placement of Full-Thickness Skin Grafts

BACKGROUND: The "unsuture" technique originally reported with the use of fast-absorbing gut for the placement of full-thickness skin grafts has provided years of successful full-thickness graft placement without the need for suture removal. OBJECTIVE: The objective was to explore another option for successful graft placement and survival using irradiated polyglactin 910 (Vicryl Rapide, Ethicon Inc, Somerville, NJ, USA), with its longer tensile strength of 7 to 10 days. METHODS: Irradiated polyglactin 910 was used to suture the edges and place basting sutures in full-thickness skin grafts. RESULTS: In our experience, we have found that the use of irradiated polyglactin 910 for the placement of full-thickness skin grafts provides an alternative to the "unsuture" technique with fast-absorbing gut. It provides excellent graft survival, easy workability, low inflammation, and good long-term cosmesis, without the need for suture removal. CONCLUSION: Irradiated polyglactin 910 provides another option for the placement of full-thickness skin grafts without the need for suture removal.     

A randomized clinical trial comparing two methods of fascia closure following midline laparotomy.

Three hundred forty women undergoing midline laparotomy were randomized into an interrupted suture (polyglactin 910, size 1) or a continuous suture (polyglyconate, size 0) closure group. The two groups were well balanced with respect to various risk factors for postoperative wound complications. Early evaluation revealed no differences between the continuous and interrupted suture groups with respect to wound infection (3% vs 1%), superficial wound dehiscence (2% vs 4%), and deep wound dehiscence (0.6% vs 0%). Late evaluation showed no differences between the two groups either. Continuous polyglyconate and interrupted polyglactin 910 sutures had a similar incidence of suture fistula (0% vs 2%), wound pain (1% vs 2%), and incisional hernia (3% vs 4%). Continuous closure was done faster and resulted in less foreign-body suture material. Despite its smaller diameter, the polyglyconate suture also retains a higher tensile strength after surgery than does the quicker-degrading polyglactin 910 suture. Results of this study lead to the conclusion that a running polyglyconate suture is the better choice for closure of the abdominal-wall fascia following midline laparotomy.     

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.     

Study of the efficacy of coated Vicryl plus antibacterial suture in an animal model of orthopedic surgery

PURPOSE: To evaluate the efficacy in vitro and in vivo of a new antibacterial suture, polyglactin 910 suture with triclosan, compared with a traditional braided suture, polyglactin (Vicryl), in a validated animal model of orthopedic infection. Our primary goal was to compare the microbiologic effectiveness of the two sutures. The secondary goal was to evaluate histopathologic signs of an inflammatory response. METHODS: We used 20 Sprague-Dawley rats. Samples of Staphylococcus epidermidis were diluted to a 0.5 McFarland concentration (100,000 colony-forming units/mL). A surgical steel suture was placed in the spinous process of the rats, and the deep zone of the incision was contaminated bilaterally. Wounds were closed with one of the sutures. After 16 days, the animals were sacrificed, and the surgical wounds were reopened, with cultures being performed of both the zone adjacent to the implant and the deep region of the wound. We also studied the histopathologic features of the tissue adjacent to the implant. RESULTS: No clinical signs of infection were observed. The culture of the zone adjacent to the implant was positive in nine animals in the polyglactin group vs. three in the polyglactin 910 with triclosan group (p = 0.005). Culture of the deep zone of the wound was positive in ten animals in the polyglactin group vs. six in the polyglactin 910 with triclosan group (p = 0.03). We found predominant polymorphonuclear neutrophil populations in four samples in the polyglactin group vs. two in the polyglactin 910 with triclosan group. CONCLUSIONS: Under simulated conditions of severe intraoperative contamination, the antibacterial suture reduced the number of positive cultures after surgery by 66.6%. Judging from the available clinical information, its use might contribute to reducing the number of infected implants by 25.8%. Human studies are needed to determine the clinical implications of these results.