An In Vitro and In Vivo Evaluation of Tensile Strength and Durability of Seven Suture Materials in Various pH and Different Conditions: An Experimental Study in Rats

Abstract

Development in material engineering provide many kinds of suture materials to medical fields. The choice of utilization depends on the surgeons decision, the durability, absorbtion times, tensile strength of the suture, and operation site in means of organ and tissue. In this study we aimed to investigate 7 different suture materials in vivo and in vitro conditions to evaluate the properties and durability. Basal tensile strength (TS) values of all sutures were measured and 168 Wistar albino rats were utilised in vivo groups. The sutures were placed in the bladder, stomach, intestine and bile duct (after obstructive jaundice). Urine and bile of rat, pH 1 and pH 10 were used as in vitro conditions. Seven different suture materials (Maxon, Vicryl, Plain Catgut, Surgical Silk, Polypropylene, Caprosyn and Biosyn) were investigated in 9 different in vitro and in vivo conditions. All sutures were chosen to be in size 5/0. In the following 5th day the sutures were tested related to durability and stability. Results were compared stastically using the Mann-Whitney U test and p < 0.05 was considered as stastically significant. Among all the suture materials only polypropylene proved to preserve its stability in vivo and in vitro surveys. Cat-gut and caprosyn lost its TS in all medias. Silk and biosyn lost its TS in all conditions except the stomach and intestines. Maxon also lost its TS in all condition except urine. Utilisation of caprosyn and biosyn in urinary procedures reduces stone formation and infections. The suture of choice in biliary tract should be vicryl, maxon or biosyn since polypropylene preserves its stability that could result in stone formation. In intestinal operations polypropylene, vicryl, and silk could be preferred.

Tensile strength and failure load of sutures for robotic surgery

“…Other approaches such as grasper mounted shear sensors are also under investigation and can ultimately provide accurate real-time data regarding the state of the suture 21 . Despite previous research on suture tensile strength, the limited availability of more recent data on failure loads of commonly used sutures has prevented the development of warning systems that can accurately predict and prevent suture breakage before it occurs 22–26 . More specifically, we are interested in the failure load of sutures under conditions that occur during manipulation of sutures with robotic instruments.…”

Quality of Adhesions After Sutured Paramedian vs. Laparoscopic Toggle Abomasopexy in an Ovine Model

“…Adhesions were present in all 10 cows and were present 1 year after the initial surgery . The tensile strength of polydioxanone is less than 50% of its initial strength at 6 weeks and is completely absorbed by 180 days . As a result, it is difficult to conclude that a nonabsorbable suture material is needed for prolonged adhesion formation.…”

“…Abomasopexy by a right paramedian approach has been performed using absorbable suture material, most commonly chromic gut, to adhere the abomasum to the abdominal wall. Chromic gut has less tensile strength than most synthetic absorbable suture materials and has an absorption rate that is increased in the presence of biological fluids containing high levels of proteolytic enzymes . Although the amount of tension or suture strength needed to resist recurrence of abomasal displacement is unknown.…”

“…Furthermore, based on information obtained from colopexies performed with chromic gut in horses, we surmise the adhesion formed will show evidence of being altered as early as 30 days, making its use as a long‐term preventative for displaced abomasum suboptimal. Polydioxanone could be an alternate suture material to be used in abomasopexy because 80% of its initial strength remains after 14 days and up to 50% remains at 35 days . Overall, resorption time of polydioxanone is ∼180 days and is unaffected by tissue condition and proteolytic enzymes.…”

“…Polydioxanone could be an alternate suture material to be used in abomasopexy because 80% of its initial strength remains after 14 days and up to 50% remains at 35 days . Overall, resorption time of polydioxanone is ∼180 days and is unaffected by tissue condition and proteolytic enzymes. The intent of an abomasopexy is to only include the seromuscular layer of the abomasum, but there is risk of penetrating the abomasal lumen, exposing the suture material to an acidic environment, suggesting that polydioxanone may be a more reliable choice for pexy formation.…”