Analysis of tissue inflammatory response, fibroplasia, and foreign body reaction between the polyglactin suture of abdominal aponeurosis in rats and the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone and polyester/porcine collagen meshes

ABSTRACT Purpose To compare tissue inflammatory response, foreign body reaction, fibroplasia, and proportion of type I/III collagen between closure of abdominal wall aponeurosis using polyglactin suture and intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen meshes to repair defects in the abdominal wall of rats. Methods Forty Wistar rats were placed in four groups, ten animals each, for the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen meshes or suture with polyglactin (sham) after creation of defect in the abdominal wall. Twenty-one days later, histological analysis was performed after staining with hematoxylin-eosin and picrosirius red. Results The groups with meshes had a higher inflammation score (p < 0.05) and higher number of gigantocytes (p < 0.05) than the sham group, which had a better fibroplasia with a higher proportion of type I/III collagen than the tissue separating meshes (p < 0.05). There were no statistically significant differences between the three groups with meshes. Conclusions The intraperitoneal implant of polypropylene/polyglecaprone and polyester/porcine collagen meshes determined a more intense tissue inflammatory response with exuberant foreign body reaction, immature fibroplasia and low tissue proportion of type I/III collagen compared to suture with polyglactin of abdominal aponeurosis. However, there were no significant differences in relation to the polypropylene mesh group.

Cicatrização da musculatura reto-abdominal em coelhos submetidos à laparorrafia com fios de sutura à base de quitosana, categute cromado e poliglactina 910 / [Healing of the rectus abdominis muscle in rabbits submitted to laparorrhaphy with suture-based chitosan, chromic catgut and polyglactin 910]

Objetivou-se, com este estudo, avaliar o processo de cicatrização da musculatura reto-abdominal em coelhos submetidos à laparorrafia, utilizando-se o fio de sutura à base de quitosana, comparando-o aos fios de categute cromado e poliglactina 910. Foram utilizados 24 coelhos adultos, divididos aleatoriamente em quatro grupos: quitosana e categute 15 dias (QC-15dias), quitosana e categute 30 dias (QC-30 dias), quitosana e poliglactina 910 15 dias (QP-15 dias) e quitosana e poliglactina 910 30 dias (QP-30 dias). Cada grupo foi composto por seis coelhos, nos quais foram realizadas duas incisões, uma do lado direito e outra do lado esquerdo e, posteriormente, a laparorrafia, com o fio de quitosana de um lado e o categute cromado ou poliglactina 910 do outro. Realizou-se análise clínico-cirúrgica, histológica e avaliação de achados de necropsia, além de testes de citotoxicidade e de mecânica no fio de quitosana. Ele apresentou baixa resistência mecânica e citotóxica. O fio de quitosana não proporcionou uma cicatrização satisfatória em coelhos, pois desencadeou uma resposta inflamatória acentuada.(AU)

The objective of this study was to evaluate the healing process of the recto-abdominal muscles in rabbits submitted to laparorrhaphy using chitosan-based suture yarn, comparing it to chrome catgut and polyglactin 910 yarns. Twenty-four adult rabbits were divided in to four random groups: chitosan and polyglactin 910 15 days (QP-15 days) and chitosan and polyglactin 910 30 days (QC-30 days), chitosan and polyglactin 910 15 days (QP-15 days) QP-30 days). Each group consisted of six rabbits, in which two incisions were made, one on the right side and one on the left side, and later the laparorraphy with the chitosan yarn on one side and chromed catgut or polyglactin 910 on the other. Clinical-surgical, histological and necropsy findings were evaluated, as well as cytotoxicity and mechanical tests on the chitosan wire. It presented low mechanical and cytotoxic resistance. Chitosan thread did not provide satisfactory healing in rabbits, as it triggered a marked inflammatory response.(AU)

Pain, healing and satisfaction of women after perineal repair with surgical glue and suture / Dolor, cicatrización y satisfacción de la mujer después de la reparación perineal con pegamento quirúrgico e hilo de sutura / Dor, cicatrização e satisfação da mulher após reparo perineal com cola cirúrgica e fio de sutura

Abstract OBJECTIVE To compare the intensity of pain, the healing process and women's satisfaction with the repair of perineal trauma during vaginal delivery using surgical glue or suture. METHOD Cross-sectional study aligned with a clinical trial conducted at a maternity in Itapecerica da Serra, São Paulo. The sample consisted of women who were evaluated between 10 and 20 days after delivery. The outcomes were analyzed according to the distribution of women in the experimental group (EG: perineal repair with Glubran-2® surgical glue; n=55) and in the control group (CG: perineal repair with Vicryl® suture thread; n=55). RESULTS 110 puerperal women were evaluated. There was no difference between EG and CG regarding sociodemographic and clinical-obstetric characteristics. The intensity of perineal pain, assessed by the visual numeric scale was lower among women in the EG compared to the CG (p<0.001). According to the REEDA scale, there was no significant difference in perineal healing (p=0.267) between EG and CG. The satisfaction of women with perineal repair, assessed using a five-point scale, was higher with the use of surgical glue (p=0.035). CONCLUSION Surgical glue showed advantages in relation to perineal pain and greater satisfaction for women compared to the use of suture. The healing process was similar for both types of repair.

Resumen OBJETIVO Comparar la intensidad del dolor, el proceso de cicatrización y la satisfacción de la mujer con la reparación del trauma perineal durante el parto normal utilizando pegamento quirúrgico o hilo de sutura. MÉTODO Estudio transversal anidado a un ensayo clínico realizado en el hospital-maternidad de Itapecerica da Serra, São Paulo. La muestra consistió en mujeres que fueron evaluadas entre 10 y 20 días después del parto. Los resultados se analizaron según la distribución de las mujeres en el grupo experimental (GE: reparación perineal con pegamento quirúrgico Glubran-2®; n=55) y en el grupo control (GC: reparación perineal con hilo Vicryl®; n=55). RESULTADOS Se evaluaron 110 mujeres en el postparto. No hubo diferencia entre GE y CG en cuanto a las características sociodemográficas y clínico-obstétricas. La intensidad del dolor perineal, evaluada mediante la escala numérica visual, fue menor entre las mujeres del GE en comparación con aquellas del GC (p<0,001). Según la escala REEDA, no hubo diferencias significativas en la cicatrización perineal (p=0,267) entre el GE y GC. La satisfacción de las mujeres con la reparación perineal, evaluada mediante una escala de cinco puntos, fue mayor con el uso de pegamento quirúrgico (p=0,035). CONCLUSIÓN El pegamento quirúrgico mostró ventajas con relación al dolor perineal y mayor satisfacción de las mujeres, en comparación con el hilo de sutura. El proceso de cicatrización fue similar para ambos tipos de reparación.

Resumo OBJETIVO Comparar a intensidade da dor, o processo de cicatrização e a satisfação da mulher com o reparo do trauma perineal no parto normal por meio de cola cirúrgica ou fio de sutura. MÉTODO Estudo transversal alinhado a um ensaio clínico realizado na maternidade de Itapecerica da Serra, São Paulo. A amostra foi constituída por mulheres que foram avaliadas entre 10 a 20 dias após o parto. Os desfechos foram analisados segundo a distribuição das mulheres no grupo experimental (GE: reparo perineal com cola cirúrgica Glubran-2®; n=55) e no grupo controle (GC: reparo perineal com fio Vicryl®; n=55). RESULTADOS Foram avaliadas 110 puérperas. Não houve diferença entre GE e GC quanto às características sociodemográficas e clínico-obstétricas. A intensidade da dor perineal, avaliada pela escala visual numérica, foi menor entre as mulheres do GE em comparação ao GC (p<0,001). Segundo a escala REEDA, não houve diferença significativa na cicatrização perineal (p=0,267) entre GE e GC. A satisfação das mulheres com o reparo perineal, avaliada por escala de cinco pontos, foi maior com o uso da cola cirúrgica (p=0,035). CONCLUSÃO A cola cirúrgica mostrou vantagens em relação à dor perineal e maior satisfação das mulheres comparada com o uso do fio de sutura. O processo de cicatrização foi similar nos dois tipos de reparo.

Effect of using triclosan-impregnated polyglactin suture to prevent infection of saphenectomy wounds in cabg: a prospective, double-blind, randomized clinical trial

Abstract Objective: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. Results: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). Conclusion: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.

Evaluation of polypropylene and polyglactin sutures in primary sphincteroplasty for the treatment of anal fistula in rats / Avaliação dos fios de polipropileno e poliglactina na esfincteroplastia primária no tratamento da fístula anal em ratos

ABSTRACT Rationale: Fistulotomy followed by primary sphincteroplasty is one of the therapeutic options in transsphincteric fistulae; however, it was not known which suture would present a better result. Objective: To compare polypropylene and polyglactin sutures in primary sphincteroplasty in rats subjected to fistulotomy. Method: Thirty Wistar rats were subjected to peritoneal anesthesia with ketamine and xylazine, followed by transfixation of the anal sphincter with steel thread, which remained for 30 days to develop the anal fistula. After this period, the steel thread was removed and four groups were formed: A - Control (n = 5), without treatment; B - Fistulotomy (n = 5), performed fistulotomy only; C - Polypropylene (n = 10), in which fistulotomy was performed followed by primary sphincteroplasty with polypropylene suture; D - Polyglactin (n = 10), in which fistulotomy was performed followed by primary sphincteroplasty with polyglactin suture; after 30 days the animals were anesthetized again and submitted to euthanasia by deepening the anesthetic plane to remove the specimens, analyzing fistula closure, muscle fiber distance, and inflammatory process. Results: The fistula persisted in all animals of the control group and in none of the other groups; the distances between the muscle fibers were 1620 µm, 4665 µm, and 2520 µm, respectively in Groups B, C, and D (p = 0.067); in relation to fibrosis, the means were 2.4, 2.8, and 3.6, respectively in Groups B, C, and D, showing greater fibrosis in the latter group (p = 0.041). Conclusion: There was no persistence of the fistula in any of the treated animals; there was no difference in the distance between the muscle fibers between the groups subjected to primary sphincteroplasty with polypropylene or polyglactin, or between these groups and the one treated only by fistulotomy. There was greater fibrosis in animals treated with primary sphincteroplasty with polyglactin.

RESUMO Racional: A fistulotomia seguida de esfincteroplastia primária é uma das opções terapêuticas nas fístulas transesfincterianas, porém, não se sabe ao certo qual fio poderia apresentar melhor resultado. Objetivo: Comparar os fios de polipropileno e poliglactina na esfincteroplastia primária em ratos submetidos a fistulotomia. Método: Utilizou-se 30 ratos Wistar, confeccionada fístula por transfixação do esfíncter anal com fio de aço, que permaneceu por 30 dias. Após, o fio de aço foi removido e foram formados quatro grupos: A - Controle (n = 5), sem tratamento; B - Fistulotomia (n = 5), realizada fistulotomia apenas; C - Polipropileno (n = 10), em que foi realizada fistulotomia seguida por esfincteroplastia primário com fio de polipropileno; D - Poliglactina (n = 10), mesmo procedimento com fio de poliglactina; após 30 dias analisou-se o fechamento da fístula, afastamento dos cabos musculares e processo inflamatório. Resultados: A fístula persistiu em todos animais do grupo controle e em nenhum dos demais grupos; dos grupos tratados a área de afstamento dos cabos musculares foi 1620 µm, 4665 µm e 2520 µm, respectivamente nos Grupos B, C e D (p = 0,067); em relação à fibrose as médias foram 2,4; 2,8 e 3,6; respectivamente nos Grupos B, C e D, demonstrando maior fibrose neste último grupo (p = 0,041). Conclusão: Não houve persistência da fístula em nenhum dos animais tratados, não houve diferença no afastamento dos cabos musculares entre os grupos submetidos a esfincteroplastia primária com polipropileno ou poliglactina, e nem destes com o grupo tratado apenas por fistulotomia. Houve maior fibrose nos animais tratados por esfincteroplastia primária com poliglactina.

Routine use of v-lock® suture for bariatric anastomosis is safe: comparative results from consecutive case series / Uso rotineiro da sutura v-lock® para anastomoses em obesidade é seguro: resultados de estudo clínico comparativo

ABSTRACT Background: In high-income countries, morbid obesity is a growing health problem that has already reached epidemic proportions. When performing a laparoscopic gastric bypass several operative methods exist. Aim: To describe the institutional experience using a knotless unidirectional barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery. Methods: Evaluation of a case series of 87 morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were divided into two groups: in group I, GJA und JJA sutures were performed using the knotless unidirectional barbed suture; in group II, GJA and JJA were sutured with resorbable multifilament thread (Vicryl® 3/0 Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score, operative time, postoperative morbidity, length of hospital stay, and reoperation, were analyzed and compared. Results: All procedures were completed laparoscopically with no mortality. The mean operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group II (p<0.05). The postoperative complications did not differ significantly between the two groups. Early complications were observed for two patients (0.9%) in the barbed suture group and for one patient (0.42%) in the multifilament suture group (p<0.05). In group I two patients (0.9%) required reoperation: on the basis of jejunojejunal stenosis in one patient, and local abscess near the gastrojejunostomy, without a leakage, in the other. In group II one patient (0.42%) required reoperation due to stenosis of the GJA. The duration of hospital admission was similar for both groups: 3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II (p<0.05). Conclusion: The novel anastomotic technique is a safe and effective method and can be applied to gastrojejunal anastomosis and jejunojejunal anastomosis in laparoscopic gastric bypass.

RESUMO Racional : Em países de alta renda, a obesidade mórbida é um problema crescente de saúde que já atingiu proporções epidêmicas. Ao realizar um bypass gástrico laparoscópico, existem vários métodos operatórios. Objetivo: Descrever a experiência institucional utilizando uma sutura farpada unidirecional sem nós (V-Loc 180/Covidien, Mansfield, MA) para criar gastrojejunostomia (JJ) e jejunojejunostomia (JJ) costuradas à mão durante a cirurgia bariátrica. Métodos: Avaliação de uma série de casos com 87 pacientes obesos mórbidos submetidos ao bypass gástrico por videolaparoscopia com gastrojejunostomia (JJA) e jejunojejunostomia (JJA) suturados à mão entre 01/2015 e 06/2017. Os pacientes foram divididos em dois grupos; no grupo I, GJA e JJA as suturas foram realizadas com a sutura farpada unidirecional sem nós e, no grupo II, com sutura multifilamentar reabsorvível (Vicryl® 3/0 Ethicon, Livingstone, UK). Foram analisados ​​e comparados os dados registrados sobre gênero, idade, IMC, escore ASA, tempo operatório, morbidade pós-operatória, tempo de internação hospitalar e reoperação. Resultados: Todos os procedimentos foram concluídos por laparoscopia sem mortalidade. O tempo cirúrgico médio foi 123,23 (±30,631) no grupo I e 127,57 (±42,772) no grupo II (p<0,05). As complicações pós-operatórias não diferiram significativamente entre os dois grupos. Complicações precoces foram observadas em dois pacientes (0,9%) no grupo de sutura farpada e um (0,42%) no de sutura multifilamentar (p<0,05). No grupo I, dois pacientes (0,9%) necessitaram de reoperação; um devido à estenose jejunojejunal e abscesso local próximo à gastrojejunostomia, sem vazamento, no outro. No grupo II, um paciente (0,42%) necessitou de reoperação por estenose da GJA. O tempo de internação hospitalar foi semelhante nos dois grupos: 3,36 (±0,743) dias no grupo I vs. 3,38 (±1,058) dias no grupo II (p<0,05). Conclusão: A nova técnica de anastomose é método seguro e eficaz e pode ser aplicado nas anastomoses gastrojejunal e jejunojejunal no bypass gástrico laparoscópico.

Study on the mechanical properties of sutures in the process of suturing / 生物医学工程学杂志

Suture broken, knot slipping and tissue tearing are the main reasons of wound closure failure in clinical operation. Based on this, we simulated the suturing and healing operation by using a biological materials testing machine and investigated the tensile properties before and after knotting, relaxation property and friction property of three common sutures: silk, polyglactin 910 and polypropylene. Results show that the tensile property decreased after knotting. The tensile strength of polyglactin 910 and elongation of polypropylene were the largest. During the relaxation process, the sutures relaxed the most in the first 2 hours. The relaxation from less to more was: polyglactin 910, silk and polypropylene. Coating or monofilament could obviously reduce the surface roughness of sutures, and thus reduce the friction force of the suture-suture interface. The friction force of the suture-suture interface increased with the increasing load but did no change with the increasing velocity. The results can provide an important theoretical basis for the optimizations of suture design and knotting operation.

In Vivo Safety and Regeneration of Long-Term Transported Amniotic Fluid Stem Cells for Renal Regeneration

BACKGROUND: Despite major progress in stem cell therapy, our knowledge of the characteristics and tissue regeneration potency of long-term transported cells is insufficient. In a previous in vitro study, we established the optimal cell transport conditions for amniotic fluid stem cells (AFSCs). In the present study, the target tissue regeneration of long-term transported cells was validated in vivo. METHODS: For renal regeneration, transported AFSCs were seeded on a poly(lactide-co-glycolide) scaffold and implanted in a partially resected kidney. The target tissue regeneration of the transported cells was compared with that of freshly harvested cells in terms of morphological reconstruction, histological microstructure reformation, immune cell infiltration, presence of induced cells, migration into remote organs, expression of inflammation/fibrosis/renal differentiation-related factors, and functional recovery. RESULTS: The kidney implanted with transported cells showed recovery of total kidney volume, regeneration of glomerular/renal tubules, low CD4/CD8 infiltration, and no occurrence of cancer during 40 weeks of observation. The AFSCs gradually disappeared and did not migrate into the liver, lung, or spleen. We observed low expression levels of proinflammatory cytokines and fibrotic factors; enhanced expression of the genes Wnt4, Pax2, Wt1, and Emx2; and significantly reduced blood urea nitrogen and creatinine values. There were no statistical differences between the performance of freshly harvested cells and that of the transported cells. CONCLUSION: This study demonstrates that long-term transported cells under optimized conditions can be used for cell therapy without adverse effects on stem cell characteristics, in vivo safety, and tissue regeneration potency.

Comparative study of fibrosis induced by Marlex®, Parietex Composite®, Vicryl® and Ultrapro® meshes1

Abstract Purpose: To evaluate the fibrosis induced by four different meshes: Marlex®, Parietex Composite®, Vicryl® and Ultrapro®. Methods: Histological cutouts of abdominal wall were analyzed with polarized light 28 days after the meshes implants and colorized by picrosirius to identify the intensity of collagen types I and III, and their maturation index. Results: When the four groups were compared, the total collagen area analyzed was bigger in groups A and D, with no difference between them. The collagen type I density was bigger in group A, with an average of 9.62 ± 1.0, and smaller in group C, with an average of 3.86 ± 0.59. The collagen type III density was similar in groups A, B and C, and bigger in group D. The collagen maturation index was different in each of the four groups, bigger in group A with 0.87, group B with 0.66, group D with 0.57 and group C with 0.33 (p = 0.0000). Conclusion: The most prominent fibrosis promotion in the given meshes was found on Marlex® (polypropylene mesh) and the Parietex Composite® (non-biodegradable polyester); the collagen maturation index was higher in the Marlex® mesh, followed by Ultrapro®, Parietex Composite® and Vicryl® meshes.

Comparative study of polyglactin 910 and simple catgut in the formation of intraperitoneal adhesions

Abstract Purpose: To compare polyglactin 910 and simple catgut sutures for the incidence of intraperitoneal adhesions. Methods: Twenty female Wistar rats were placed into two groups. Group 1 received ischemic sutures and Group 2 received polyglactin 910. Five sutures inductive of adhesions in each rat were made. After 14 days, the rats were euthanized with an assessment of the presence of adhesions, the number of sutures involved and classification according to the Granat et al. scale described by Ozel et al17. Results: In total, 19 of the 20 rats presented adhesions, with nine from Group 1 and ten from Group 2. There was a smaller number of affected sutures in Group 1, while in Group 2 the majority of the sutures formed adhesions (p=0.0197). According to the Granat et al. scale, Group 1 predominately developed fine, filamentous adhesions or thickening in a restricted area. Group 2 mainly presented extensive, thick adhesions with the involvement of the viscera (p=0.0055). Conclusion: Polyglactin 910 sutures formed more adhesions that were more extensive and thicker than the simple catgut sutures.

A comparative study of immediate wound healing complications following cleft lip repair using either absorbable or non-absorbable skin sutures

OBJECTIVES: The aim of the study was to compare wound healing complications following the use of either absorbable or non-absorbable sutures for skin closure in cleft lip repair. MATERIALS AND METHODS: This was a randomized controlled trial conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria. Sixty subjects who required either primary or secondary cleft lip repair and satisfied all the inclusion criteria were recruited and randomized into two groups (Vicryl group or Nylon group). The surgical wounds in all subjects were examined on 3rd, 7th, and 14th postoperative days (POD) for presence or absence of tissue reactivity, wound dehiscence, and local wound infection. RESULTS: Hemorrhage, tissue reactivity, wound dehiscence, and local wound infection were identified as wound healing complications following cleft lip repair. The incidence of postoperative wound healing complications on POD3 was 33.3%. Tissue reactivity was more common throughout the evaluation period with the use of an absorbable (Vicryl) suture compared to a non-absorbable (Nylon) suture, although the difference was statistically significant only on POD7 (P=0.002). There were no significant differences in the incidences of wound dehiscence and infection between the two groups throughout the observation period. CONCLUSION: There were no statistically significant differences in the incidences of wound dehiscence and surgical site wound infection following the use of either Vicryl or Nylon for skin closure during cleft lip repair. However, more cases of tissue reactivity were recorded in the Vicryl group than in the Nylon group on POD7. Particular attention must be paid to detect the occurrence of wound healing complications, most especially tissue reactivity, whenever a Vicryl suture is used for skin closure in cleft lip repair.

Effect of Poly(Lactide-Co-Glycolide) Nanoparticles on Local Retention of Fluorescent Material: An Experimental Study in Mice

OBJECTIVE: Poly(lactide-co-glycolide) (PLGA) nanoparticles are promising materials for the development of new drug-releasing systems. The purpose of this study was to evaluate the in vivo retention time of materials loaded in nanoparticles as compared with that of the material alone by in vivo imaging in nude mice. MATERIALS AND METHODS: Mice (n = 20) were injected with 0.1 mL fluorescent material 1,1′-dioctadecyl-3,3,3′,3′ tetramethylindotricarbocyanine iodide (DiR)-loaded PLGA nanoparticles (200 nm) into the right paraspinal muscle, and the same volume of pure DiR solution was injected into the left paraspinal muscle. Fluorescence images were obtained using an in vivo optical imaging system. Fluorescent images were taken 1 day after the injection, and seven more images were taken at 1-week intervals. Image analysis was done with ImageJ program, and one region of interest was chosen manually, which corresponded to the highest signal-intensity area of fluorescence signal intensity. RESULTS: After 7 weeks, 12 mice showed a right-sided dominant signal, representing the DiR loaded PLGA nanoparticles; 5 mice showed a left-side dominant signal, representing the free DiR solution; and 3 mice showed no signal at all beginning 1 day after the injection. During the 7-week period, the mean signal intensities of the free DiR solution and DiR-loaded PLGA nanoparticles diverged gradually. On day 1, the mean signal intensity of free DiR solution was significantly higher than that of DiR-loaded PLGA (p < 0.001). Finally, by week 7, DiR-loaded PLGA express significantly high signal intensity compared with free DiR solution (p = 0.031). CONCLUSION: The results of the current study suggested that therapeutic agents bound to PLGA nanoparticles may exhibit prolonged retention times.

The Efficacy of Midline Barbed Absorbable Sutures in Progressive Tension Closure of Abdominal Flap Donor Sites

BACKGROUND: The donor site of abdominal flaps for breast reconstruction consists of a wide suprafascial cavity that poses a risk of seroma formation. The authors evaluated the efficacy of continuous progressive tension sutures (PTS) using unidirectional barbed absorbable sutures for decreasing the volume of fluid collection and the risk of seroma at the abdominal donor site. METHODS: Between March 2013 and February 2015, 37 consecutive patients underwent breast reconstruction using a deep inferior epigastric artery perforator flap. Two patients who underwent salvage operations were excluded. Ten patients underwent standard abdominal flap donor site closure without PTS. Seven received donor site closure with interrupted Vicryl PTS between the abdominal flap and abdominal muscle fascia. Eighteen patients underwent closure with continuous PTS using unilateral barbed absorbable sutures. Body mass index, the approximate flap area, the duration of drain maintenance, the total drained volume, and the incidence of seroma were compared across these 3 groups. The operative time and subjective difficulty perceived by the surgeon was compared between the 2 PTS groups. RESULTS: The total drained volume was lower and the duration of drain maintenance was shorter in both PTS groups than in the standard closure group. There were no cases of seroma in the PTS groups, and 2 that resolved with conservative care in the standard closure group. More time was required and the subjective difficulty score was significantly higher for interrupted PTS than for continuous PTS. CONCLUSIONS: Continuous PTS effectively reduced the duration of drain insertion, the total volume of drained fluid, and was swifter and easier to perform than interrupted PTS.

Nylon, fibrin glue and Vicryl®- the graft fixation techniques in the conjunctival autotransplant for the treatment of primary pterygium / Nylon, cola de fibrina e Vicryl® - Avaliação da fixação do enxerto no autotransplante conjuntival para tratamento do pterígio primário

Abstract Objective: to compare nylon, fibrin glue and Vicryl® in the conjunctival autograft for treatment of primary pterygium. Methods: Prospective study approved by the Ethics Committee following the Declaration of Helsinki. 89 eyes were underwent pterygium excision and conjunctival autograft. They were grouped according to the technique: fibrin glue, nylon 10-0 and 8-0 Vicryl® and followed up for 3 months. Surgical Time, intra and postoperative symptoms, biomicroscopic signs, ocular discomfort ( by Visual Analogue Scale), aesthetic appearance and recurrences (day 21, 90 and 3 years) were evaluated. Results: The operative time was shorter with the fibrin glue (p<0.001). As to intraoperative symptomatology, burning sensation predominated with Vicryl® (p=0,012). The postoperative symptoms and signs: on day 1- secretion with fibrin glue (p=0.02), foreign body sensation (p=0.017) and subconjunctival hemorrhage (p=0.022) with Vycril®; on day 7- chemosis (p=0.035), hyperemia (p<0.001) and eyelid edema (p=0.011) with Vicryl®; on day 21-foreign body sensation (p=0.001) and conjunctival hyperemia (p<0.001) with nylon; on day 90- dry eye (p=0.005) with Vicryl®. Ocular discomfort was greater with Vycril® (p=0.015) on day 7. Final aesthetic appearance was superior with fibrin glue (p=0.003). The recurrences was greater on day 90: 20,7%(nylon), 10%(fibrin glue) and 19%(Vicryl®) (p=0.496) and after 3 years: 4.8% in NG, 0% in FGG, and 5.3% in VG (p=0.536). Conclusion: Fibrin glue showed efficacy, rapidity, less postoperative discomfort and better final aesthetic appearance. Vicryl® showed significant intraoperative and early postoperative symptoms and obvious signs of inflammation, beside ocular discomfort on day 7. Nylon caused more foreign body sensation and conjunctival hyperemia until its removal. The signs of recurrence were similar among the groups.

Resumo Objetivo: comparar o nylon, a cola de fibrina e o Vicryl® no autotransplante conjuntival para o tratamento do pterígio primário. Métodos: estudo prospectivo aprovado pelo Comitê de Ética seguindo a Declaração de Helsinque. 89 olhos foram submetidos à excisão de pterígio e autotransplante conjuntival, agrupados conforme as técnicas: nylon 10-0, cola de fibrina, e Vicryl® 8-0, acompanhados por 3 meses. Tempo cirúrgico, sintomas intra e pós-operatórios, sinais biomicroscópicos, desconforto ocular (Escala Analógica Visual), aspecto estético, recorrências no 21º e 90º dia pós-operatório e aos 3 anos. Resultados: O tempo operatório foi menor com a cola de fibrina e maior com Vicryl® (p<0,001). Sintomatologia intra-operatória: a ardência predominou com Vicryl® (p=0,012). Sintomas e sinais pós-operatórios significativos: no 1º dia, secreção com cola de fibrina (p=0,02), sensação de corpo estranho (p=0,017) e hemorragia subconjuntival (p=0,022) com Vycril®; No 7º dia - quemose (p=0,035), hiperemia (p<0,001) e edema da pálpebra (p=0,011) com Vicryl®; No 21º dia - sensação de corpo estranho (p=0,001) e hiperemia conjuntival (p<0,001) com nylon; No 90º dia - olho seco (p=0,005) com Vicryl®. Desconforto ocular: maior com Vycril® (p=0,015) no 7º dia. Aparência estética final: melhor com a cola (p=0,003). Sinais de recidiva: maior no 90º dia: 20,7%(nylon), 10%(cola) e 19%(Vicryl®) e após 3 anos: 4,8%(nylon), 0%(cola) e 5.3%(Vicryl®) (p=0,536). Conclusão: A cola de fibrina mostrou eficácia, rapidez, menor desconforto pós-operatório e melhor aspecto estético; o Vicryl®, maiores sintomas intraoperatórios, pós-operatórios iniciais e sinais evidentes de inflamação, aliados ao desconforto ocular no 7º dia; o nylon, mais sensação de corpo estranho e hiperemia conjuntival até sua remoção. Os sinais de recidiva foram semelhantes entre os grupos.

Differences between polydioxanone and poliglactin in intestinal anastomoses - a comparative study of intestinal anastomoses / Diferenças entre polidioxanona e poliglactina em anastomoses intestinais - estudo comparativo de anastomoses intestinais

ABSTRACT Introduction: Intestinal anastomosis is a surgical practice constantly realized by surgeons worldwide. When the option is to perform manual anastomosis, which is still widely used for its low cost, the question arises as to the best material to be applied. Objective: To compare polydioxanone and polyglactin threads for healing and tensile strength in intestinal anastomosis in rats. Method: We used 25 rats Wistar; after anesthesia, in groups A and B (10 rats each), laparotomy was performed, transection of the ileum at 5 and 10 cm proximally to the ileocecal valve; in group A, anastomosis was performed with 4 separate extra mucosal sutures with polidioxanone; in group B, anastomosis was performed with polyglactin; in group C (5 rats), laparotomy and manipulation of the ileum were performed. After 21 days, the animals were anesthetized and submitted to euthanasia. The specimens were sent for histopathological study and tensile strength analysis. Statistical analysis was performed using the Turkey and Student's t tests, with a significance of p < 0.05. Results: The results showed that in the tensile strength analysis, there were no significant differences between them. The histological analysis showed significant differences between the cicatrization pattern, where polydioxanone caused less fibrosis than polyglactin. Conclusion: Polydioxanone caused less fibrosis than polyglactin in intestinal anastomoses of rats.

RESUMO Introdução: Anastomose intestinal é uma prática cirúrgica constantemente realizada pelos cirurgiões em todo o mundo. Quando a opção é a anastomose manual - um procedimento ainda amplamente empregado, graças a seu baixo custo - coloca-se o problema de saber qual é o melhor material a ser aplicado. Objetivo: Comparar fios de polidioxanona e poliglactina quanto à cicatrização e resistência à tração em anastomoses intestinais em ratos. Método: Utilizamos 25 ratos Wistar; depois da anestesia, foi realizada laparotomia nos grupos A e B (10 ratos cada), com transecção do íleo a 5 e 10 centímetros proximalmente à válvula ileocecal; no grupo A, a anastomose foi realizada com 4 suturas de mucosa separadas com uso de polidioxanona; no grupo B, a anastomose foi realizada com poliglactina; no grupo C (5 ratos), foi realizada apenas a laparotomia e manipulação do íleo. Transcorridos 21 dias, os ratos foram anestesiados e submetidos à eutanásia. Os espécimes foram enviados para estudo histopatológico e análise de resistência à tração. A análise estatística foi efetuada com a aplicação dos testes de Tukey e de t de Student, com significância de p < 0,05. Resultados: Os resultados demonstraram que, na análise de resistência à tração, não foram observadas diferenças significativas entre os materiais. A análise histológica revelou diferenças significativas entre padrões de cicatrização, em que polidioxanona causou menos fibrose versus poliglactina. Conclusão: Polidioxanona causou menos fibrose versus poliglactina em anastomoses intestinais realizadas em ratos.

Novas perspectivas no diagnóstico e tratamento da acropostite-fimose em touros / New perspectives in the diagnosis and treatment of acropostitis-phimosis of bulls

A acropostite-fimose é um processo inflamatório da extremidade do prepúcio, diagnosticada com frequência em touros. O presente estudo objetivou avaliar o exame ultrassonográfico na definição da viabilidade do folheto prepucial interno (FPI) e na evolução clínica do pós-operatório, após o emprego de fios de categute ou poliglactina na hemostasia e de algodão ou poliglactina na confecção de sutura padrão Donatti empregada para fixar o FPI à pele prepucial no transoperatório da acropostite-fimose em touros. A sutura utilizada foi captonada ou não captonada, e os animais submetidos ao procedimento cirúrgico apresentavam no mínimo dois terços do FPI viável. Os touros foram alocados, aleatoriamente, em quatro grupos contendo nove animais cada, de acordo com o fio empregado na hemostasia e na confecção da sutura padrão Donatti. O exame ultrassonográfico mostrou-se importante na indicação ou não do tratamento cirúrgico da acropostite-fimose e possibilitou localizar lesões, mensurar a área de reação tecidual e identificar lesões profundas e pontos de estreitamento do FPI. Os animais de GII apresentaram edema mais discreto, observando-se diferença significativa (P<0,05) entre GII e os grupos GI, GIII e GIV. A ocorrência de hiperemia no sétimo dia de pós-operatório também foi menor nos touros do grupo GII, ocorrendo diferença significativa (P<0,05) entre GII e os grupos GI e GIII. A sutura empregando o dispositivo de látex (cápton) e o emprego do fio de poliglactina apresentaram-se como medidas benéficas, resultando em menor número de complicações pós-operatórias.(AU)

Acropostitis-Phimosis is an inflammatory process of the extremity of the prepuce, frequently diagnosed in bulls. The present study aimed to evaluate ultrassound exams in the definition of viability of the internal layer of prepuce and the postoperative clinical evolution. This evaluation is after the employment of catgut or poliglactin threads in homeostasis, and cloth or polyglactin threads in confection of the standard suture, Donatti, used to fix the internal layer of prepuce to the preputial in the postoperative of acropostitis-phimosis in bulls. The suture was captonated and non-captonated and the animals conducted to the surgical procedure showed at least 2/3 of viability of the internal layer of prepuce. The bulls were randomly allocated in four groups, each one containing nine animals, according to the thread used in homeostasis and confection of the Donatti standard suture. Ultrassound was shown to be important in the indication or not of the surgical treatment of acropostitis-phimosis and allowed the identification of lesions, measurement of areas of tissue reaction and locate deep lesions and narrowing points of internal layer of prepuce. The employment of latex device (capton) in suture and the employment of polyglactin thread 910 were shown as beneficial measures, resulting in a lower number of postoperative complications.(AU)

Comparative study of Polypropylene versus Parietex composite®, Vicryl® and Ultrapro® meshes, regarding the formation of intraperitoneal adhesions

Abstract Purpose: To compare the polypropylene mesh (Marlex®) to Vicryl®, Parietex composite® and Ultrapro® meshes to assess the occurrence of adhesions in the intraperitoneal implantation. Methods: Sixty Wistar rats were allocated into three groups: PP+V, in which all the animals received a polypropylene and a Vicryl® mesh; PP+PC, with the implantation of polypropylene and Parietex composite® meshes and PP+UP, in which there was implantation of polypropylene and Ultrapro®. Macroscopic analysis was performed 28 days later to assess the percentage of mesh area affected by adhesion. Results: in the PP+ V group, the Vicryl® mesh showed lower adhesion formation (p=0.013). In the PP+PC, there were no differences between polypropylene and Parietex composite® (p=0.765). In the PP+UP group, Ultrapro® and polypropylene meshes were equivalent (p=0.198) . Conclusion: All the four meshes led to adhesions, with the Vicryl® mesh showing the least potential for its formation.

Implantless Fixation of a Large Osteocartilaginous Fracture of the Lateral Femoral Condyle in a Child

We describe for the first time a case of lateral femoral condyle fracture following a fall in a 13-year-old child that was reduced arthroscopically using a probe. It was definitively fixed with 0 vicryl sutures in a cruciate pattern after being initially stabilised with 1.5-mm Kirschner wires. Four beath pins carrying sutures were drilled at four opposing quadrants through the reduced fragment into the femur. The sutures were then tied on the lateral cortex of the femur. After fixation, the child was kept non-weight bearing for 6 weeks, partial weight bearing from 6 weeks to 12 weeks and then full weight bearing thereafter. Range of motion (ROM) exercises were commenced on the first postoperative day. At one-year follow-up, the ROM was from −5° to 130°, all symptoms disappeared, and complete resumption of all sports activities was allowed.

Results of Absorbable Mesh Insertion and Patient Satisfaction in Breast-Conserving Surgery

PURPOSE: Breast-conserving surgery (BCS) is a standard treatment for breast cancer. Occasionally, patients may be dissatisfied with the breast shape due to deformity after BCS. To ensure satisfactory cosmetic results, a procedure with absorbable mesh after BCS was introduced in 2005. The purpose of this study was to identify the safety and effectiveness of this procedure. METHODS: From November 2013 to December 2015, patients who underwent BCS for a malignant breast mass at Jeonju Presbyterian Medical Center were reviewed, and 63 patients were included in this study. Based on data collected from medical records and telephone interviews, the subjects were divided into two groups as follows and retrospectively compared and analyzed: BCS with absorbable mesh (n=31) and BCS without absorbable mesh (n=32). Patient data included age, body mass index, underlying disease, tumor location and size, specimen size, operative time, axillary dissection based on frozen biopsy results, postoperative wound infection, postoperative radiotherapy, adjuvant chemotherapy, and follow-up period. To compare patient satisfaction between the two groups, a brief questionnaire consisting of four items was administered. RESULTS: Infection occurred in six patients (19.4%) in the absorbable mesh group and one (3.1%) in the BCS only group; however, the difference was not significant (p=0.053). Overall satisfaction, postoperative pain and postoperative motion limitation between the two groups were also not statistically significantly different. However, patients who underwent BCS with absorbable mesh insertion were better satisfied with the breast shape than those who underwent BCS without mesh from 1 year after operation (p=0.011). CONCLUSION: BCS with absorbable mesh is a simple and easy method to improve patient satisfaction for breast shape.

Effect of Drug Carrier Melting Points on Drug Release of Dexamethasone-Loaded Microspheres

Here, we examined the effect of melting point of drug carriers on drug release of dexamethasone (Dex)-loaded microspheres. We prepared poly(L-lactide-ran-ε-caprolactone) (PLC) copolymers with varying compositions of poly(εcaprolactone) (PCL) and poly(L-lactide) (PLLA). As the PLLA content increased, the melting points of PLC copolymers decreased from 61 to 43 ℃. PLC copolymers in vials solubilized at 40–50 ℃ according to the incorporation of PLLA into the PCL segment. Dexamethasone (Dex)-loaded PLC (MCxLy) microspheres were prepared by the oil-in-water (O/W) solvent evaporation/extraction method. The preparation yields were above 70%, and the mean particle size ranged from 30 to 90 µm. The MC(x)L(y) microspheres also showed controllable melting points in the range of 40–60 ℃. Dex-loaded MC(x)L(y) microspheres showed similar in vitro and in vivo sustained release patterns after the initial burst of Dex. The in vitro and in vivo order of the Dex release was MC₈₀L₂₀>MC₉₀L₁₀>MC₉₅L₅, which agreed well with the melting point order of the drug carrier. Using in vivo fluorescence imaging of fluorescein (FI)-loaded microspheres implanted in animals, we confirmed the sustained release of FI over an extended period. In vivo inflammation associated with the PLC microsphere implants was less pronounced than that associated with Poly(lactide-co-glycolide) (PLGA). In conclusion, we successfully demonstrated that it is possible to control Dex release using Dex-loaded MC(x)L(y) microspheres with different melting points.