Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model

Klink, Christian D.; Binnebösel, Marcel; Alizai, H. P.; Lambertz, Andreas; vonTrotha, Klaus T; Junker, Elmar; Disselhorst‐Klug, Catherine; Neumann, Ulf; Klinge, U.

doi:10.1186/1471-2482-11-36

Cited by 33 publications

(28 citation statements)

References 19 publications

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“…Additionally, a completely tension-free suture implantation like in this study is not possible in surgical practice. Since conventionally used sutures are known to cut through and damage the enclosed tissue [34], the use of materials with elastic properties could be a future perspective to improve the success of sutures. …”

Section: Discussionmentioning

confidence: 99%

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma

et al. 2015

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Background: Biocompatibility and tissue integration of a surgical suture are decisive factors for wound healing and therefore for the success of sutures. The optimal suture material is still under discussion. Polyvinylidene fluoride (PVDF) is described to have superior properties of biocompatibility and is therefore frequently used as a mesh component. Only little information is available about its use as a suture material. The aim of this study was to evaluate the biocompatibility of PVDF as a suture material in comparison to 5 different established sutures in a rat model. Methods: In 30 male rats, a monofilamental PVDF suture (Resopren®) and 5 established control suture materials [polyester (Miralene®), polytetrafluoroethylene (Gore®), poliglecaprone (Monocryl®), polydioxanone (Monoplus®), polyglactin 910 (Vicryl®), USP size 3-0] were placed in the subcutaneous layer of the abdominal wall without knot or tension. After 3, 7 or 21 days, the abdominal walls were explanted for histopathological and immunohistochemical investigation with special regard to the size and quality of foreign body granuloma and the length of the comet tail-like infiltrate (CTI). Results: The PVDF sutures showed the smallest size of foreign body granuloma (60 ± 14 µm) and the smallest CTI length (343 ± 60 µm) of all polymers after 21 days. Only PVDF (Resopren) and polydioxanone (Monoplus) showed a significant collagen I/III ratio increase between days 3 and 21 (p = 0.009 and p = 0.016). The quality of foreign body reaction regarding inflammation, proliferation and fibrotic remodeling was similar between all suture materials. Conclusions: Our data indicate that monofilamental PVDF sutures show a favorable foreign body reaction with small granuloma sizes and CTI length in comparison to established sutures. Its use as a suture material in general surgery could therefore be extended in the future. To reinforce these findings, further clinical studies need to be conducted.

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Section: Discussionmentioning

confidence: 99%

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma

et al. 2015

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“…The plotted data from the continuous suture tension experiments were analyzed at baseline, 1 min, and after 30 min. As shown in earlier experiments by Klink et al, the decrease in suture tension can be divided into two distinct phases. The rapid cutting phase is defined as the rapid decrease in suture tension during the first minute after application of the suture.…”

Section: Methodsmentioning

confidence: 69%

“…The polymer is seen as a material with good biocompatibility being a stable and relatively inert material and being able to induce only a moderate inflammatory reaction, with the ability to remain in the human body for extended periods of time . However, one of the negative aspects of this material is the relatively high bending stiffness, because some degree of elasticity is required for materials like sutures and meshes . For this reason, it is important to look for alternative materials with comparable biocompatibility, but less bending stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 One hypothesis is that high suture tension is a cause for many wound healing complications, because of the necrosis and tissue destruction within the suture loops. 1,5,6 This tissue damage is thought to be caused by constriction of tissue and eventually cutting of the suture through tissues. 1,6 One of the simplest solutions to this problem would be to reduce the suture tension to the desired level.…”

Section: Introductionmentioning

confidence: 99%

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Biocompatibility and biomechanical analysis of elastic TPU threads as new suture material

et al. 2015

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High suture tension is one of the causes for many wound-healing problems. Constriction of tissue within the suture loops of nonelastic sutures can lead to cutting of the suture through tissues and necrosis of the tissue within these loops. The use of elastic materials in new suture types could give the material the ability to adapt tension to the tissue requirements and subsequently lead to more vital tissue within its loops. We evaluated the foreign body host response, as indicator of biocompatibility, to a new thermoplastic poly(carbonate) urethane (TPU) synthetic suture material in a rat model compared with standard nonelastic polypropylene (PP) sutures. Tissue samples were collected at 7 and 21 days, and host response was evaluated. Subsequently, suture tension curves of the new elastic sutures for the first 30 min after knotting were recorded in a pig model. The new TPU sutures showed an improved foreign body response when compared with that of PP, with a reduction in the amount of macrophages surrounding the material. Tension experiments showed a superior tension curve for TPU sutures, with a major reduction in peak suture tension when compared with that of standard PP sutures, while still retaining adequate tension after 30 min. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 99-106, 2017.

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“…Too great a tensile force per suture results in more scar tissue6 16. The holding force of a suture depends on the collagen that is deposited in the suture, best achieved by suturing the aponeurosis without muscle or fat tissue20. Long‐term follow‐up studies will show whether the protective effect of small bites can be maintained.…”

Section: Discussionmentioning

confidence: 99%

Development of incisional herniation after midline laparotomy

Harlaar

Deerenberg

Dwarkasing³

et al. 2017

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BackgroundIncisional herniation is a common complication after abdominal surgery associated with considerable morbidity. The aim of this study was to determine whether incisional hernia is an early complication, in order to understand better the aetiology of incisional hernia formation.MethodsThis study involved the secondary analysis of a subset of patients included in a large RCT comparing small and large tissue bites (5 mm every 5 mm, or 1 cm every 1 cm) in patients scheduled to undergo elective abdominal surgery by midline laparotomy. The distance between the rectus abdominis muscles (RAM distance) was measured by standardized ultrasound imaging 1 month and 1 year after surgery. The relationship between the 1‐year incidence of incisional hernia and the RAM distance at 1 month was investigated.ResultsSome 219 patients were investigated, 113 in the small‐bites and 106 in the large‐bites group. At 1 month after surgery the RAM distance was smaller for small bites than for large bites (mean(s.d.) 1·90(1·18) versus 2·39(1·34) cm respectively; P = 0·005). At 1 year, patients with incisional hernia had a longer RAM distance at 1 month than those with no incisional hernia (mean(s.d.) 2·43(1·48) versus 2·03(1·19) cm respectively; relative risk 1·14, 95 per cent c.i. 1·03 to 1·26, P = 0·015).ConclusionA RAM distance greater than 2 cm at 1 month after midline laparotomy is associated with incisional hernia. Closure with small bites results in a smaller distance between the muscles.

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Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model

Cited by 33 publications

References 19 publications

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma

Biocompatibility and biomechanical analysis of elastic TPU threads as new suture material

Development of incisional herniation after midline laparotomy

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