Absorbable and nonabsorbable sutures in microsurgery: Standardized comparable studies in rats

Abstract

In order to study the applicability and value of synthetic absorbable suture materials in microvascular surgery, 8-0 monofilament nonabsorbable polyamide sutures and 8-0 absorbable polyglycolic acid and polyglactin 910 sutures were used in end-to-end anastomoses of the aorta in rats, employing the same microsurgical model for all procedures. Comparable investigations of the anastomotic sites were carded out macroscopically and histologically at various intervals postoperatively. It was found that when placed under unphysiologic strain, microvascular anastomoses sutured with absorbable materials had less mechanical endurance than anastomoses stitched with nonabsorbable suture materials. It was also found, however, that this had no significance in vivo, inasmuch as no vascular ruptures or aneurysms appeared with either the absorbable or nonabsorbable sutures even after long-term observation. The nonabsorbable sutures were fully recognizable up to 150 days, microscopically showing clear evidence of granuloma formation. The absorbable sutures, on the other hand, could hardly be discerned after 50 days, and after 150 days the foreign body and scar reactions had almost completely disappeared. Absorbable suture materials lead to more rapid restitution of the vascular wall than nonabsorbable sutures and consequently appear to be superior.

Replantation in children

“…Animal research indicates that the use of absorbable suture may have advantages for the very young patient, possibly decreasing the incidence of long-term foreign body reaction and aneurysm formation. 18, 19 Immediately before beginning the anastomosis, systemic heparin is administered at a dose of 1,000 units for smaller children and 3,000 units for those close to adult weight. If the procedure is lengthy, serial doses of heparin, 500-1,000 units per hour, should be given.…”

Do-It-Yourself Microsuture from Human Hair for Basic Microsurgical Training

“…However, several studies showed that absorbable monofilament (polydioxanone, PDS) or absorbable braided microsuture (polygalactic acid, Vicryl) can be used with comparable results. [8][9][10][11][12] Although comparable, these types of microsutures are very expensive ($30-40 U.S. dollars per piece) and highly consumable materials, especially in new and novice microsurgical trainees beginning their microsurgical practice in surgical skill laboratories. From the literature reviews, alternative suture materials that were previously reported as standard microsutures in microsurgical skill laboratories were small filaments from large braided polyfilaments, 13 spider silk, 14 fishing line, 15 and human hair.…”

Cambios morfológicos secundarios a material de sutura quirúrgica

“…La elección del tipo de material de sutura dependerá no sólo de si se trata de vasos o tejidos, sino de si la sutura es o no reabsorbible 4 ; por ejemplo, en el caso de sutura vascular y gastrointestinal es recomendable que sea reabsorbible 5,6 . El hallazgo durante la autopsia de cambios morfológicos de un órgano, tejido o vaso puede llevar a confusión con nódulos tumorales o metastásicos, y el diagnóstico sólo será exacto si se realiza un estudio histopatológico, como ocurrió en el caso expuesto.…”