Silk and polyglycolic acid in oral surgery: a comparative study.

The inflammatory reaction caused by 2 different suture materials, black silk and polyglycolic acid, was evaluated 8 days after application and permanence in the oral environment. A randomized sample of 55 patients, aged 9 to 76, who had undergone oral urgery was examined. The suture materials (30 black silk and 25 polyglycolic acid), soon after removal, were placed in sterile containers and transferred to the laboratory. A bacterial count was carried out and the sutures were observed under light microscope (x100 magnification) to indirectly evaluate the inflammatory reaction. All patients were recommended to properly disinfect the wound with a 0.2% chlorhexidine solution. The inflammatory reaction of gingival tissues was lower for polyglycolic acid compared to silk sutures. However, the wound conditions, evaluated 8 days after surgery, were acceptable in patients treated with both silk and polyglycolic acid sutures. The use of chlorhexidine solution did not significantly affect the presence and type of microorganisms in either kind of suture.     

镍钛记忆合金皮内缝合对甲状腺手术切口愈合的影响

目的:探究甲状腺手术缝合时采用镍钛记忆合金皮内缝合对切口愈合的影响。方法:回顾性分析2018年1月-2019年1月125例在笔者医院行甲状腺手术患者相关资料,依据患者术后缝合方式分为合金皮内缝合组(n=60)与丝线间断缝合组(n=65),分别应用镍钛记忆合金皮内缝合与丝线间断缝合。比较两组患者术后恢复情况,切口愈合情况,切口瘢痕情况,切口美观优良率。结果:合金皮内缝合组患者术后疼痛持续时间、切口愈合时间以及住院时间均明显短于丝线间断缝合组患者,差异具有统计学意义(P<0.05);两组患者切口缝合时间比较差异没有统计学意义(P>0.05)。合金皮内缝合组患者切口愈合情况明显优于丝线间断缝合组,且切口瘢痕优良率明显高于丝线间断缝合组,差异具有统计学意义(P<0.05)。合金皮内缝合组与丝线间断缝合组切口美观优良率分别为95.00%与78.46%,差异有统计学意义(P<0.05)。结论:甲状腺手术切口缝合时应用镍钛记忆合金皮内缝合可以促进切口快速愈合,在保证切口美观优良率情况下促进患者快速康复,临床应用价值高。     

Experimental study of tensile strength at arterioprosthetic anastomosis

An experimental study was conducted to investigate the possible role of the suture materials in occurrence of false aneurysms at the suture line. Mature mongrel dogs were used in the experiment. A segment of abdominal aorta was replaced by woven Teflon graft. Braided silk was used as the suture material on one side, and polyglycolic acid suture on the other. The dogs were sacrificed one to 16 weeks after the operation, and the implanted prostheses were excised along with the abdominal aorta. The tensile strengths of the anastomosis on both ends of the graft were calculated. The tensile strength of the braided silk consisted about 8% of the total tensile strength at 16 weeks after surgery. The degree of sliding of the synthetic graft at the anastomotic site and the outer layer of the graft were analyzed at each measurement of tensile strength. In the 1st Department of Surgery, Yokohama City University Hospital 125 arterial synthetic prostheses have been implanted in patients during 1964 to 1982. False aneurysms occurred in 9 cases. The incidence was 19.2% in the cases where silk suture material was used but was 4.0% when synthetic suture material was used. It was concluded that the use of synthetic grafts was preferable, since it conjoined well with the outer layer. Furthermore, the plastic suture material did not degenerate and seemed to prevent the occurrence of false aneurysm.     

肠吻合采用不同缝线对克罗恩病术后复发的影响

目的探讨克罗恩病（CD）患者在肠切除吻合时使用不同缝线对CD术后复发的影响．方法回顾性分析2002年1月至2010年1月在南京军区南京总医院行肠切除肠吻合术的102例CD患者的临床资料,比较采用可吸收线（可吸收线组,48例）与丝线（丝线组,54例）进行缝合的患者术后内镜复发和临床复发情况。结果可吸收线组和丝线组术后1、2、3年累计临床复发率分别为6．3％、14．6％、22．9％和18．5％、27．8％、35．2％。差异无统计学意义（P=0．213）;两组术后1年和2年累计内镜复发率分别为14．7％、38．2％和22．9％、62．9％,差异有统计学意义（P=0．034）。结论CD患者在实施肠切除吻合术时采用可吸收线进行缝合相对于丝线能够显著降低CD术后内镜复发率;可吸收线可考虑作为CD肠吻合的首选缝合材料。     

Chromic suture material as a nidus for common duct stone formation

Several surgeons have reported finding silk suture material as a nidus for common duct stones after cholecystectomy. They have therefore advocated the use of chromic sutures to ligate the cystic duct in order to avoid this complication. A case report is presented in which chromic suture material was found to be the source of common duct stone formation after cholecystectomy. A review of the literature indicated the relative infrequency of foreign suture material causing this problem. The suture used in the routine ligation of the cystic duct should be left to the technical preference of the surgeon.     

The choice of a suture to close abdominal incisions

Burst abdomen, incisional hernia and sinus formation continue to bedevil the surgeon. Significant associated factors include postoperative wound infection and the suture material used. A series of experiments was therefore designed to test suture materials for their use in infected abdominal would closure. The nearest to the ideal, is a monofilament nonabsorbable suture (monofilament nylon). It has a low infectivity, resulted in satisfactory would tissue strength when used in infected wounds, and retained its strength. Infected, braided sutures of silk, nylon and polyglycolic acid even after 70 days were seen to contain bacteria and polymorphonuclear cells when examined electron microscopically. Absorption of silk and polyglycolic acid and encapsulation of non-absorbable braided nylon was delayed by the presence of infection. Monofilament nylon, in contrast, was unaffected, a fibrous capsule having formed by 10 days even in the infected state.     

The electrical and sodium transport characteristics of sutured premalignant mouse colon

Depolarization of the plasma membrane and increased sodium influx have both been suggested as mitogenic signals. Following bowel resection the intestinal suture line has been reported a fertile site for tumor recurrence. Whether alterations in cell surface signaling occur at suture lines has not been previously examined the electrical changes of sodium transport occurring at a suture line in an animal model of large bowel cancer. Forty-eight female CF1 mice underwent colotomies with repair utilizing silk or chromic sutures. Twenty-four mice underwent sham operations to serve as controls. The mice were injected subcutaneously with the carcinogen DMH (1,2-dimethylhydrazine) 20 mg/kg or an identical volume of 0.9% saline for 6 weeks and were sacrificed 1 week after the last injection. The sites of the sutured colotomies or a piece of distal colon from the sham-operated mice were mounted in a modified Ussing chamber and the electrical properties and unidirectional sodium fluxes were measured. The potential difference (pd) across the distal colon was not significantly different in any suture group compared to that in sham-operated controls when treated with saline (pd sham, -2.3 +/- 0.2 mV (mean +/- SEM); silk, -1.7 +/- 0.3 mV, chromic, -1.9 +/- 0.3 mV, P greater than 0.05, unpaired Student t test). The potential difference was significantly lowered in both suture groups compared to sham operated animals after treatment with DMH (pd sham, -2.6 +/- 0.3 mV; silk, -1.5 +/- 0.2 mV, P less than 0.05; chromic, -1.6 +/- 0.4 mV, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical repair of a vesicovaginal fistula guided by a black braided silk suture line

The purpose of the study was to evaluate the effect of the identification of the margins of a vesicovaginal fistula (VVF) during its repair by passing a black braided silk suture line through the fistula. During the repair of a VVF, a suture line was placed through the fistula. By passing the suture line from the vagina through the fistula tract into the bladder and hence to the outside through the urethral meatus, the circumference of the VVF opening can be easily identified after dissection and excision of the vaginal wall around the fistula opening. There were four VVF patients who underwent a modified Latzko procedure using the thread to guide surgical repair. The operation times and blood loss were 45–90 min and no more than 50 ml, respectively. This trick provides adequate identification of the fistula tract, thus permitting safe and easy fistula repair for a narrow, deep, or atrophic vagina.     

Usefulness of Absorbable Sutures in Preventing Surgical Site Infection in Hepatectomy

We evaluated the usefulness of synthetic absorbable sutures (Vicryl) in preventing surgical site infection (SSI) after hepatectomy. A rat model of 60% partial hepatectomy was used. Bleeding from the cut surface of the liver was controlled by using two suture types: silk and Vicryl. In the Vicryl group, the lesser omentum was slightly adherent to the cut surface of the liver, while in the silk group, the suture remained, and severe adhesions were found. The number of Staphylococcus aureus was significantly larger in the silk group. We compared a group of patients (n = 125) who underwent hepatectomy using silk with one (n = 188) using Vicryl. The respective incidences of SSI and infection on the cut surface of the liver in the Vicryl group (3.2, 1.6%) were significantly lower than in the silk group (11.2, 8.8%). In accordance with the results of multivariate analysis, duration of operation, use of silk sutures and the complication of bile leakage were selected as independent factors. The risk of SSI in the silk group was 3.4 times that in the Vicryl group. The use of synthetic absorbable sutures, instead of silk sutures, in all the procedures of hepatectomy contributed significantly to the prevention of SSI.     

Anastomotic suture granuloma following radical retropubic prostatectomy

We report 2 cases of symptomatic suture granuloma formation after erosion of the silk suture (used to ligate the dorsal venous complex) into the urethrovesical anastomosis. Irritative or obstructive voiding complaints, sterile pyuria or hematuria found after radical retropubic prostatectomy mandates urological evaluation, including cystoscopy to rule out anastomotic suture granuloma formation. Although erosion appears to be a rare occurrence, we recommend use of absorbable suture to control the dorsal venous complex and avoid this possible complication.     

An in vitro evaluation of the stability of mechanical properties of surgical suture materials in various pH conditions.

The effects of pH on the tensile properties of eight commonly used 2-0 suture materials--plain catgut, Dexon, Vicryl, silk, Nurolon, Ethilon, Mersilene, and Prolene--were examined. The pH level ranged from 3.0 to 10.0. In general, absorbable suture materials were more sensitive to pH than non-absorbable suture materials; within the same suture materials, a strong alkaline condition would have a more adverse effect on the strength of suture materials than physiologic and acidic pHs. Plain catgut sutures lost relatively significant amounts of strength at both acidic and alkaline conditions when compared with Dexon and Vicryl sutures; hence, precaution should be taken when they are used in closing tissues in contact with acidic environment like the stomach. Among the non-absorbable suture materials, silk and Nurolon exhibited the largest loss of strength in both alkaline and acidic environments after one month, while other sutures retained almost all of their original strength. Physical configuration of the suture materials seemed also to contribute to the sensitivity of suture materials toward pH. A comparison of Nurolon and Ethilon sutures demonstrated this point of view.     

无钛夹腹腔镜胆囊切除术在基层医院的应用

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术中应用无钛夹丝线结扎法的可行性、适应证和临床价值。方法：回顾分析应用腔内丝线结扎技术为60例患者行LC的临床资料。结果：8例行四孔法LC,余均行三孔法LC,无中转开腹。手术时间30~90min,平均50min,术后住院2~6d,均痊愈出院,未发生胆管损伤、胆漏、出血及胆管结石等并发症。5例Winslow孔放置多孔乳胶引流管,引出淡血性渗出液10~100ml/d,术后1~3d拔除。结论：无钛夹丝线结扎法用于LC具有结扎可靠、术后患者疼痛轻、创伤小、康复快、经济等优点,并可避免因钛夹残留、移位和游走所致的并发症。只要选择病例合适,精心训练,在基层医院开展结扎法LC是安全、有效、可行的。     

Which Suture Material is Optimal for Pancreaticojejunostomy Anastomosis? An In Vitro Study

Background: Which suture material is optimal for pancreaticojejunostomy (PJ) anastomosis is a matter of debate with contradictory results. The aim of the present in vitro study was to determine the effects of pancreatic juice, bile, and their mixture on different suture materials in terms of breaking strength and disintegration. Material and Methods: Four suture materials, silk, polyglactin 910, polydioxanone, and polypropylene, were tested in pancreatic juice, bile, and their mixture. Determination of breaking strength and disintegration under electron microscope for each suture material was done on days 0, 3, 6, and 10. Results: The breaking strength of polyglactin 910 and silk was significantly higher than polypropylene and polydioxanone (p < .05). Polyglactin 910 significantly lost its breaking strength with time in pancreatic juice, bile, and their mixture (p < .001). The breaking strength of each type of suture did not significantly alter in pancreatic juice, bile, and their mixture at the baseline measurement and at the end of the experiment (p > .05). No obvious disintegration has been observed under electron microscope in the architecture and appearance of suture materials after days of exposure to pancreatic juice, bile, and their mixture. Conclusions: None of the suture materials was disintegrated on exposure to pancreatic juice, bile, and their mixture. Polyglactin 910 has the highest breaking strength and significantly loses its strength throughout the experiment but still remains higher than other suture materials. Polypropylene, polydioxanone, and silk showed less variation across the incubation period.     

The effects of laser-assisted fibrinogen bonding on suture material.

To evaluate the effect of laser-assisted fibrinogen bonding on the tensile strength of suture material, 10 types of sutures were exposed to various time intervals of diode laser energy after pretreatment with dye-enhanced fibrinogen solder. After exposure, each suture material was stressed on a tensometer and compared with nonlased suture material. Our results indicate that polytetrafluoroethylene suture material was virtually unaffected at all time intervals of exposure to laser energy. Polyester suture material retained 64.3% of its tensile strength at 60 sec of exposure to laser energy. White silk suture material maintained 80% of its initial tensile strength at 60 sec of exposure. These suture materials may be used safely in conjunction with laser-assisted fibrinogen bonding even if prolonged laser exposure is necessary. The other suture materials tested may be compromised significantly by prolonged exposure to laser energy and must be used with relatively shorter irradiation periods.     

改良胸腔镜下肺动脉成形术在全肺切除术中的应用

目的探讨改良胸腔镜下肺动脉成形术在全肺切除术中应用的可行性。方法2012年4～10月,我科对15例侵犯肺门的肺癌行改良胸腔镜下肺动脉成形联合全肺切除术,与传统方法不同之处在于游离肺静脉、肺动脉及支气管后,在阻断肺动脉时,采用0号不可吸收丝线环绕肺动脉主干2周后收紧,暂不打结,将线的两端用蚊式钳固定于操作孔周围的无菌中单,然后将哈巴狗钳置于0号线远端约5mm处,远端血管使用0号线阻断。结果10例左全肺切除联合纵隔淋巴结清扫术,5例右全肺切除联合纵隔淋巴结清扫术。肺动脉成形时间平均14min（10～19min）,平均手术时间180．6min（120～231min）,平均出血量100ml（50～250ml）。术中、术后未输血,无围手术期并发症发生。术后病理：10例鳞癌,2例腺癌,2例小细胞肺癌,1例大细胞肺癌;病理分期：ⅢA期12例,ⅡB期2例,ⅡA期1例。平均住院时间7d（6～9d）。14例术后随访1年,1例术后5个月死于对侧肺部感染,1例术后10个月死于脑转移,余12例无复发。结论改良肺动脉成形方法可行。     

Effect of human pancreatic juice and bile on the tensile strength of suture materials

BACKGROUND: Several suture materials are used for pancreatojejunal anastomosis. In this study, we tested the durability of these suture materials in human pancreatic juice and bile. METHODS: Plain and chromic catgut, polyglactin 910, polyglycolic acid, polydioxanone, polypropylene, and silk sutures were incubated in pancreatic juice and bile that was collected from patients. Fifteen samples of each type of suture material were placed in human juices for 1, 3, and 7 days. Tensile strengths were measured with a tensionmeter. RESULTS: Plain and chromic catgut disintegrated in pancreatic juice and pancreatic juice plus bile mixture. Polyglycolic acid and polyglactin 910 suture materials were vulnerable to pancreatic juice within 7 days. Polydioxanone retained most of its initial strength in pancreatic juice and bile. Polypropylene and silk retained 84% and 92% of their initial strength, respectively. CONCLUSIONS: We found that polidioxanone was the strongest suture material in pancreatic juice.     

可吸收生物缝合线在普外科中的应用

目的　探讨可吸收生物缝线在普外科手术中的应用价值。方法　将 12 0例施行普外科手术患者分为两组 ,观察可吸收生物缝线和普通丝线对切口愈合的影响。结果　可吸收生物缝线组患者切口并发症明显低于普通丝线缝合组 (P <0 .0 5 )。结论　可吸收生物缝线是手术缝合材料的一种创新 ,对减少切口并发症有重要的临床意义。     

Human tissue reaction to sutures.

Tissue reaction to sutures was studied in 666 specimens obtained from patients from one day to 23 years after operation. Reaction to catgut depends on the stage of absorption and is mainly histocytic in type. Nonabsorbable sutures are encapsulated by a rim of connective tissue, while near the suture histocytes, giant cells and lymphocytes are found. This is most marked with silk and cotton, less so with Dacron, and least with nylon and wire. Tissue infiltration into the suture interstics is variable. The reactions resemble the findings in experimental animals.     

Polyglycolic acid, silk, and topical ampicillin. Their use in hernia repair and cholecystectomy

The effect of topical ampicillin sodium and polyglycolic acid and silk sutures on the recurrence of an existing hernia or an incisional hernia and on infection rates in clean abdominal wounds (herniotomies and simple cholecystectomies) was studied in a triple-blind, randomized trial with 398 consecutive patients. One infection, three suture sinuses, and two incisional hernias occurred among 113 patients with cholecystectomies, while the corresponding rates in 285 patients with hernia repairs were 11 infections, no suture sinuses, and three recurrent hernias. No effect of ampicillin could be demonstrated, nor was any difference between polyglycolic acid and silk sutures shown. No interaction between the antibiotic and suture material was found, and no side effects were observed. Wound infection was significantly more frequent in patients with postoperative seromas or hematomas.     

经脐单孔腹腔镜丝线结扎法治疗精索静脉曲张20例报告

目的:探讨经脐单孔腹腔镜下用丝线结扎法治疗精索静脉曲张的疗效. 方法:回顾分析我院采用经脐单孔腹腔镜下丝线结扎法治疗20例精索静脉曲张与24例既往三孔腹腔镜法的临床效果对比. 结果:所有手术均获成功,单孔手术时间20～35 min,平均28 min,术后平均住院时间2d,三孔手术15～28 min,平均20 min,平...