Application of Suture Material Impregnated with Miramistin in Diffuse Peritonitis: Experimental-Clinical Justification

Abstract

Introduction. In diffuse peritonitis, the incidence of intestinal suture incompetence ranges from 5 to 15%, and suppuration of the surgical wound from 15% to 30%.
 The aim of research was to study experimentally the course of the wound process in the intestinal wall in diffuse peritonitis using suture material impregnated with miramistin, and to evaluate the effect of this material on the incidence of intestinal suture failure and suppuration of surgical wounds in a surgical practice.
 Materials and methods. The experimental study involved 192 male Wistar rats divided into 2 groups, 96 animals each; the clinical study involved 20 patients with traumatic intestinal tube wounds, who were also divided into 2 groups. Peritonitis was simulated by introducing 10% fecal suspension into the abdominal cavity. A laparotomy was performed in 24 hours, then the abdominal cavity was washed with sterile saline and a wound 1 cm long was performed in the colon wall. In animals of the first (control) group the wound was sutured with polyglycolide suture material without an antibacterial coating, in animals of the second (experimental) group the wound was sutured with polyglycolide suture material covered with polymer solution containing 20% Miramistin based on the polymer weight. In 10 patients of the first clinical group, intestinal wounds were sutured with similar suture materials without antibacterial coating, and the abdominal wall was sutured using interrupted stitches with lavsan suture materials. In 10 patients of the second group, wounds of the intestinal tube and the abdominal wall were sutured with suture materials impregnated with 20% Miramistin.
 Results. In animals of the first group, the pronounced phase of inflammation of the intestinal wall lasted 7 days, inflammation subsided and start of the proliferative phase was recorded in 14 days, restriction of the intestinal suture by the connective tissue elements was registered in 21 days of the experiment. In animals of the second group, the phase of inflammation lasted 3 days, the proliferative phase ended in 7 days, restriction of the intestinal suture by the new connective tissue with complete restoration of the architectonics of the intestinal wall was recorded in 14 days. In patients of the first clinical group, intestinal suture failure developed in 2 patients (20%), and surgical wound suppuration - in 4 patients (40%) with one lethal outcome. Inpatients of the second clinical group, intestinal suture failure, deaths and suppuration of surgical wounds were not registered.
 Conclusion. The use of suture material impregnated with polymer solution containing 20% miramistin by the polymer weight in peritonitis was pathogenetically justified to be effective.