In vitro antibacterial efficacy of MONOCRYL plus antibacterial suture (Poliglecaprone 25 with triclosan)

BACKGROUND: This study evaluated the in vitro efficacy of poliglecaprone 25 suture with triclosan against gram-positive and gram-negative bacteria. METHODS: Poliglecaprone 25 sutures with and without triclosan were tested for in vitro efficacy against Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, methicillin-resistant Staphylococcus epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli by a zone of inhibition assay. The suture also was tested against Escherichia coli in a colonization assay in a dynamic model simulating in vivo conditions. An in vitro triclosan diffusion assay and a sustained efficacy assay were performed by concurrent high-performance liquid chromatography and zone of inhibition assay. To assess stability, antibacterial efficacy testing was performed on samples held more than five months at elevated temperature. RESULTS: Poliglecaprone 25 suture with triclosan demonstrated significant in vitro efficacy against a range of bacteria. The suture sustained in vitro efficacy for 11 days, corresponding to the in vitro triclosan diffusion profile. CONCLUSION: Triclosan reduced in vitro colonization of poliglecaprone 25 suture by several strains of bacteria compared with untreated control sutures.     

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.     

In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture

ABSTRACT Background: This study evaluated the efficacy of polydioxanone suture with and without triclosan against gram-positive and gram-negative bacteria in vitro and in vivo. Methods: Polydioxanone suture with and without triclosan was tested against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), S. epidermidis, methicillin-resistant S. epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli by a zone of inhibition assay. In vivo evaluations were conducted in guinea pigs and mice in which test and control sutures (3-4 cm long) were implanted subcutaneously in the dorsal-lateral regions (control on left, test on right, 3-5 cm apart) through a 20 gauge catheter. Each implantation site was then challenged directly through the catheter with 4 x 10(5) colony-forming units (CFU) of S. aureus (guinea pigs) or 7 x 10(6) CFU of E. coli (mice). At 48 h post-implantation, the control and test sutures were explanted, and adherent bacteria were counted. Results: Polydioxanone suture with triclosan demonstrated activity against all test organisms in vitro. The antibacterial activity was maintained until the sutures dissolved after 17 to 23 days when tested against E. coli and S. aureus, respectively. Evaluation in animal models demonstrated a 99.9% reduction in S. aureus and a 90% reduction in E. coli relative to controls. Conclusion: Polydioxanone suture with triclosan had activity in vitro against S. aureus, MRSA, E. coli, S. epidermidis, MRSE, and K. pneumoniae that persisted for as long as three weeks. In animal models, polydioxanone suture with triclosan inhibited in vivo colonization by S. aureus and E. coli.     

Effects of physical configuration and chemical structure of suture materials on bacterial adhesion. A possible link to wound infection

The purpose of this study was to examine the effects of physical configuration and the chemical nature of suture materials on the preferential adherence of bacteria. Ten suture materials of 2-0 (chromic catgut, Dexon, Vicryl, PDS, Mersilene, Tycron, Ethibond, Surgilon, Ethilon, and Prolene) were used. The bacterial strains tested were Staph. aureus and E. coli. The level of bacterial adherence was determined quantitatively by radiolabelled cells and qualitatively by scanning electron microscopy. It was found that the amount of adhered bacteria depended on the type of suture material, the type of bacteria, and the duration of contact. In the group of absorbable sutures, the new PDS sutures exhibited the smallest affinity toward the adherence of both E. coli and Staph. aureus. Dexon sutures had the highest affinity toward these two bacteria. With nonabsorbable sutures, the physical configuration of the sutures contributed more to their ability to attract bacteria than the surface finish. The bacterial adherence on suture materials was also time dependent. Scanning electron microscope morphologic observation also indicated that Staph. aureus adhered on the suture surface in clusters whereas E. coli tended to adhere individually.     

A New Suture for Hair Transplantation: Poliglecaprone 25

BACKGROUND: The most common type of donor closure in hair transplantation is with nonabsorbable, running sutures, usually of nylon or polypropylene. This is accomplished with or without buried absorbable sutures. Another popular method of closure is with stainless steel staples. Each of these methods has benefits and limitations with respect to healing, comfort, and convenience for the patient. OBJECTIVE: The purpose of this study is to describe the use of poliglecaprone 25, a synthetic, absorbable, monofilament suture in hair transplantation surgery, to detail the suturing techniques needed to maximize the benefit of this suture, and to compare this material and suturing technique to a well-established form of closure, that of metal staples in a bilaterally controlled fashion. METHODS: Poliglecaprone 25 is a synthetic, absorbable monofilament suture of low tissue reactivity. It was compared to closure with metal staples in a bilateral controlled study. One side of the donor area was closed with poliglecaprone 25 sutures using a running cutaneous stitch and the other side was closed with stainless steel staples. Patients were evaluated with regard to healing, postoperative discomfort, resultant surgical scar, and closure material preference. RESULTS: Of the 22 patients studied, the following postoperative complaints were noted on the staples side: tenderness (12), itching (4), swelling (2), and scabbing (1). This compared to only one complaint of itching and one complaint of swelling on the poliglecaprone 25 side. Two patients had postoperative complaints of visibility of staples showing through their hair. Objective measurements revealed a wider scar overall on the staples side in six patients and wider scar on the suture side in two patients. The average scar width on the staples side measured 1.78 mm compared to 1.42 mm on the suture side. Fourteen of the 22 patients preferred poliglecaprone 25 for future procedures, 1 preferred metal staples, and 7 had no preference. Most patients stated that postoperative discomfort from the staples and the inconvenience and occasional pain associated with their removal was responsible for their decision. CONCLUSION: Poliglecaprone 25 is a strong synthetic, absorbable, monofilament suture with low tissue reactivity that can be used in hair transplantation to close the donor wound with a single, running cutaneous stitch. This suture can provide a donor closure that ensures hemostasis, has little risk of infection, and is comfortable for the patient. If specific surgical techniques are followed, this suture can provide a donor closure that ensures hemostasis has little risk of complications, is both comfortable and convenient for the patient postoperatively and results in a fine surgical scar.     

Sufentanil modifies the antibacterial activity of bupivacaine and ropivacaine

PURPOSE: The purpose of our study was to investigate the effect on the growth of Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), and Enterococcus faecalis (E. faecalis) of bupivacaine at a final concentration of 0.77 mg.mL(-1), ropivacaine at 1.2 mg.mL(-1), and sufentanil at 0.38 and 0.5 microg.mL(-1) (alone or in combination with bupivacaine and ropivacaine). METHODS: The strains were diluted to approximately 3 x 10(4) cfu.mL(-1) in Mueller-Hinton broth. The anesthetics (0.5 mL) were incubated with the bacterial suspensions (0.5 mL) for 24 hr at 37 degrees C. RESULTS: Bupivacaine inhibited the growth of E. coli (59 +/- 0.8%; P < 0.05) and S. aureus (22 +/- 3.6%; P < 0.05). Ropivacaine also inhibited the growth of E. coli (41 +/- 1.2%; P < 0.05) and S. aureus (25.5 +/- 4.1%; P < 0.05). Both anesthetics were ineffective against E. faecalis. Sufentanil only inhibited S. aureus (13.8 +/- 3.1%; P < 0.05) at a concentration of 0.5 microg.mL(-1). Sufentanil modified the antibacterial activity of bupivacaine and ropivacaine. It increased the inhibitory effect of bupivacaine on E. faecalis and S. aureus by 10 +/- 2.1% (P < 0.05) and on E. coli by 7% (P < 0.05). Sufentanil did not increase the inhibitory effect of ropivacaine on the growth of S. aureus. On the other hand, sufentanil reduced the inhibitory effect of ropivacaine on E. coli by 11% (P < 0.05). CONCLUSION: Both bupivacaine and ropivacaine alone or combined with sufentanil inhibited the growth of E. coli and S. aureus. E. faecalis was partially sensitive to a bupivacaine + sufentanil mixture. Sufentanil had a partial synergistic effect on bupivacaine and a partial antagonistic effect on ropivacaine's antibacterial activity.     

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.     

Comparative study on biocompatibility and absorption times of three absorbable monofilament suture materials (Polydioxanone, Poliglecaprone 25, Glycomer 631).

Monofilament synthetic absorbable suture materials offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual bio-absorption. An investigation was conducted on 72 rats to compare three types of monofilament absorbable suture material (Polydioxanone, Poliglecaprone 25, Glycomer 631), with respect to their clinical characteristics, tissue inflammatory reaction and suture absorption times. The results identified different qualities for each suture: Poliglecaprone 25 and Glycomer 631 suture materials were found to be less reactive than Polydioxanone in rat skin. However, because of their extremely low tissue reaction values, all three materials were deemed particularly suitable for use as intracuticular sutures. Absorption times in rat skin were less than 3 months for Poliglecaprone 25, between 3 and 6 months for Glycomer 631 and 6 months for Polydioxanone. The differences in suture characteristics which were detected in our study can help in the surgical selection of the most appropriate suture material.     

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.     

Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament,braided, and barbed sutures

Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan‐coated Vicryl Plus. In our study, sutures were cultivated on color‐change agar with Staphylococcus aureus , Staphylococcus epidermidis , Enterococcus faecium , Escherichia coli , and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (p < 0.001), but 1.4 times larger than on Ethilon II (p < 0.001) regarding S. aureus . Confocal microscopy analysis showed bacterial colonization between the braided filaments on Vicryl and beneath the barbs on Quill. From a microbiological perspective, barbed sutures can be recommended in aseptic surgery, but should only be used carefully in septic surgery. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:925–933, 2017.

     

A comparative study on primary wound closure by subcuticular suture using different suture materials with emphasis on complications, cosmesis and cost-effectiveness

Background and Purpose

There are different methods and materials for closing a surgical wound by subcuticular stitch but controversy prevails as concerns the appropriate material for this stitch. This study aims to investigate the different suture materials and compare their technical accessibility, usefulness, complication rates, patient satisfaction and, above all, the general outcome.

Methodology

Over a period of 8 months (June 2011–January 2012), 160 patients underwent wound repair by subcuticular stitch in our unit. A prospective analysis of patients’ case notes was performed. Results: Each type of thread has its own and specific type of complications which is distinct from other types of threads. Among patients on whom polyglactin sutures were used, 15.79% and 14.29% (respectively) developed complications in the presence and absence of complicating comorbid factors. Specifically, 20% of <3 cm wounds, 10% of 3–6 cm wounds, and 20% of >6 cm wounds sutured with polyglactin developed complications. The corresponding complication rates for poliglecaprone sutures were less at 9%, 5.9%, and 8.3%, respectively. The number of patients who are very happy and satisfied with poliglecaprone sutures is much greater than that of those on whom polyglactin sutures were used; the difference is statistically significant. In terms of cost, nylon is the cheapest thread whereas polypropylene is the costliest.

Conclusion

Poliglecaprone seems to be the thread of choice with minimal complication rates both in the presence and absence of comorbid factors in < 3 cm and 3–6 cm wounds. However, nylon appears to be more useful for wounds > 6cm since minimal complication rates are reported.     

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.     

Optimal sutures for use in the abdomen: an evaluation based on the formation of adhesions and abscesses

Purpose

This study explored the optimal suture materials for use in the peritoneal cavity based on the formation of adhesions and abscesses under clean and contaminated conditions.

Methods

The parietal peritoneum and muscle layer of rats were incised. The incision was followed by interrupted suturing in the clean group. A suspension of E. coli (1.0 × 10⁶) plus Bacteroides fragilis (1.0 × 10⁵) was sprayed onto the incision in the contaminated group, followed by interrupted suturing. Four types of sutures were used: nonabsorbable multifilament silk, absorbable multifilament Polyglactin 910 (Vicryl^®), absorbable monofilament Polydioxanone (PDS^®), and Poliglecaprone 25 (Monocryl^®). The rats were killed at 2, 4 or 8 weeks after the surgery.

Results

The incidence of adhesions in the clean group was low with Polyglactin 910. The incidence of adhesions was 96 % or higher regardless of the suture type in the contaminated group. The incidence of severe adhesions was low with Polyglactin 910 and Poliglecaprone 25 and significantly higher with Polydioxanone in the contaminated group. The incidence of abscess formation around the silk was significantly higher than the other three types of sutures in the contaminated group.

Conclusion

Polyglactin 910 was less likely to form adhesions than the other three types of sutures under both conditions, suggesting that Polyglactin 910 may be the optimal type of suture to use in the peritoneal cavity.     

Intracutaneous butterfly suture – a horizontal buried interrupted suture for high tension

Background: Tension on surgical wound margins frequently results following the excision of skin lesions such as tumors, naevi or scars. This tension is commonly counteracted with buried, intracutaneous, interrupted sutures of absorbable or non-absorbable material anchored vertically in the corium. Method: A horizontal, buried, intracutaneous suture has now been developed which can be more firmly anchored in the corium. It adapts and everts wound margins nearly as broadly as two vertical sutures, particularly, when the wound edges are cut obliquely with a longer rim of epidermis. When finished, the suture has a butterfly shape, whence its name. It can also be laid as a double suture (double butterfly suture). In creating this sutures, the surgeon changes the customary direction of the needle holder from horizontal to vertical. Materials: Since 1985, this suture has been made with polydioxanon in more than 30000 skin lesion excisions with very good results. In most cases the resulting narrow and smoth scars were narrow and flat in the most cases. During the study, the following suture materials were tested prospectively in 1325 patients: polyglactin 910 (Vicryl^®) (n=390), polytrimethylcarbonate (Maxon^®) (n=95), poliglecaprone 25 (Monocryl^®) (n=175), and (PDS^®) (n=665). Results: The results were unsatisfactory in only 8% of procedures. Polyglactin 910 was accompanied by somewhat more inflammation and scar dehiscence, poliglecaprone 25 by a high rate of scar dehiscence. Polytrimethylcarbonate caused skin reactions in 23% and was discontinued. Suture perforation occurred in 9%. Polydioxanon yielded the best results (p-value of the difference <0.05). Conclusions: The butterfly suture has the advantages of withstanding tension better while everting wound margins and requiring fewer stitches for wound closure. However, it is important that the suture knot be deeply anchored beneath the corium.     

Biocidal braided sutures

Once sutures become contaminated it is difficult for local tissue defenses or antibiotics to eliminate the bacteria and prevent infection. Impregnation of sutures with antibiotics before implantation is one way to prevent bacterial seeding of the suture surface. In this study, braided silk and Dacron sutures were impregnated with the antibiotic complex, neomycin palmitate. Using our standard wound model in the mouse, the efficacy of these biocidal sutures was determined in the presence of Staphylococcus aureus, Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa. Implantation of these biocidal sutures into tissue contaminated with 10(7) organisms resulted in substantially decreased numbers of bacteria as compared with that of tissue receiving control sutures. In most cases, the tissue bacterial counts in the presence of biocidal sutures were also considerably lower than that for similarly contaminated tissue without a suture. Consequently, the presence of the neomycin palmitate eliminated the infection-potentiating effect of the suture. The therapeutic benefit of the biocidal sutures was related to the dose of antibiotic complex and was not adversely affected by delaying suture implantation.     

Modified laparoscopic gastrostomy tube placement in children: Does subcutaneous suture type matter?

BackgroundLaparoscopic gastrostomy tube (GT) placement carries the risk of early tube dislodgement and is often modified with absorbable subcutaneously-tunneled transabdominal tacking sutures that can aid in tube replacement. However, these buried sutures may increase the risk of surgical site infection (SSI). This study sought to evaluate SSI rates associated with different types of transabdominal tacking sutures used in modified laparoscopic GT placement.MethodsA single-institution, retrospective review was performed of all patients ≤18 years-old undergoing modified laparoscopic GT placement between September 2016 and March 2020. Patients were stratified into three groups by suture type used, and the primary outcome was SSI within six weeks of surgery. Demographic and perioperative data were analyzed by chi-square or Fisher's exact test.ResultsA total of 113 modified laparoscopic GT placements were performed at a median age of 9 months (interquartile range 3 months to 3 years). Prophylactic antibiotic use was similar between groups. Eleven patients (10%) developed an SSI, and all were treated with antibiotics alone. No SSIs were observed with the use of poliglecaprone suture (n = 46), and higher SSI rates were observed with use of polyglactin (n = 17) and polydioxanone (n = 51) suture (18% polyglactin vs. 16% polydioxanone vs. 0% poliglecaprone, p<0.05). No differences were observed in rates of early postoperative dislodgement, leakage, or granulation tissue.ConclusionAbsorbable braided and long-lasting monofilament transabdominal tacking sutures may increase risk of SSI following modified laparoscopic gastrostomy tube placement. In this cohort, the use of poliglecaprone (Monocryl) suture was associated with no SSIs and similar rates of postoperative dislodgement, leakage, and granulation tissue.Level of Evidence: Treatment Study, Level III     

Effect of argon-beam coagulation on the integrity of suture material

PURPOSE: To evaluate the effect of argon-beam coagulator (ABC) energy on suture materials. MATERIALS AND METHODS: Six absorbable and nonabsorbable suture materials (polyglactin, chromic catgut, polydioxanone, silk, poliglecaprone, and Gore-Tex) were placed under tension and exposed to ABC energy to determine breaking times. Subsequently, all suture materials were exposed to limited ABC energy, and tensiometry was used to determine decreases in breaking strengths. RESULTS: Among the suture materials tested, Gore-Tex was the most resistant to ABC energy. Although absorbable suture materials were less resistant than nonabsorbable suture materials, 2-0 polyglactin manifested the greatest resiliance to deterioration with ABC energy exposure. CONCLUSIONS: The ABC has differential effects on suture materials. Larger-gauge suture materials are more resistant to ABC than smaller materials. Similarly, nonabsorbable sutures are generally more resilient to ABC energy than absorbable materials. Among the suture materials evaluated in our in vitro model, 2-0 Gore-Tex was best suited for vascular ligation, and 2-0 polyglactin is optimal for renal collecting system closure if ABC is anticipated as an adjunct for hemostasis.     

Use of polydioxanone absorbable monofilament sutures in orthopedic surgery

The safety and efficacy of polydioxanone absorbable monofilament sutures was documented in 57 orthopedic surgery patients (32, dyed sutures; 25, undyed sutures), 55 of whom were followed for at least 42 days postoperatively. The other two patients were lost to follow up prior to 42 days. The final clinical outcome was excellent in all completed study subjects. No suture-related adverse effects were reported. Both dyed and undyed sutures were consistently better than surgical gut with respect to pliability, strength, ease of passage, ease of tying, fraying, knot security, and overall handling. Intraoperative visibility of dyed polydioxanone sutures was consistently superior to that of surgical gut. The visibility of undyed sutures was rated better than surgical gut in 16 cases, equal in 8, and worse in 1. Both the overall handling of the polydioxanone monofilament sutures and performance as it affected wound healing were significantly superior to those of surgical gut.     

Effects of endothelin-1 on bacterial clearance in rabbits

As elevated endothelin-1 (ET-1) levels have been reported in systemic inflammatory diseases, the role of ET-1 as a promoter of inflammatory reactions is currently under investigation. The purpose of this study was to investigate the potential influence of ET-1 on systemic vascular pressure and immune function in terms of blood clearance and organ distribution of injected Escherichia coli in a rabbit model. To enable quantification of the clearance process, defined numbers of exogenous E. coli (10(8) cfu) were injected intravenously 60 min after starting the infusion of ET-1 (0.2 microgram kg-1 min-1; n = 9) or after saline infusion (controls, n = 9). Parameters monitored were arterial blood pressure, airway pressure, serum lactate concentrations and rates of bacterial elimination from the blood. At 180 min after E. coli injection, the animals were killed, and tissue samples of liver, kidney, spleen and lung were collected for bacterial counts. ET-1 infusion produced an increase in mean arterial pressure (83.9 +/- 3.9 mmHg vs. 50.1 +/- 4.1 mmHg at 120 min; P < 0.01) associated with higher serum lactate concentrations (12.6 +/- 1.3 vs. 5.4 +/- 0.3 mg dL-1; P < 0.001) and a delayed bacterial elimination from the blood compared with controls. Furthermore, there was increased colonization of the lungs (3.6 +/- 0.5 x 10(3) cfu vs. 745 +/- 120 cfu; P < 0.01), spleen (142.4 +/- 45.4 x 10(3) cfu vs. 227 +/- 5.2 x 10(3) cfu; P < 0.05) and kidney (758 +/- 329 vs. 357 +/- 151 cfu; NS), reflecting a reduced bacterial killing function.     

Bacteria Adhere Less to Barbed Monofilament Than Braided Sutures in a Contaminated Wound Model

Background

Previous studies have found fewer clinical infections in wounds closed with monofilament suture compared with braided suture. Recently, barbed monofilament sutures have shown improved strength and increased timesavings over interrupted braided sutures. However, the adherence of bacteria to barbed monofilament sutures and other commonly used suture materials is unclear.

Questions/Purposes

We therefore determined: (1) the adherence of bacteria to five suture types including a barbed monofilament suture; (2) the ability to culture bacteria after gentle washing of each suture type; and (3) the pattern of bacterial adherence.

Methods

We created an experimental contaminated wound model using planktonic methicillin-resistant Staphylococcus aureus (MRSA). Five types of commonly used suture material were used: Vicryl™, Vicryl™ Plus, PDS™, PDS™ Plus, and Quill™. To determine adherence, we determined the number of bacteria removed from the suture by sequential washes. Sutures were plated to determine bacterial growth. Sutures were examined under confocal microscopy to determine adherence patterns.

Results

The barbed monofilament suture showed the least bacterial adherence of any suture material tested. Inoculated monofilament and barbed monofilament sutures placed on agar plates had less bacterial growth than braided suture, whereas antibacterial monofilament and braided sutures showed no growth. Confocal microscopy showed more adherence to braided suture than to the barbed monofilament or monofilament sutures.

Conclusions

Barbed monofilament suture showed similar bacterial adherence properties to standard monofilament suture.

Clinical Relevance

Our findings suggest barbed monofilament suture can be substituted for monofilament suture, at the surgeon’s discretion, without fear of increased risk of infection.