Comparison of scar outcomes of alar flare region using absorbable and non-absorbable sutures: a single-blind study

Abstract Objective: Formation of scar on the face after septorhinoplasty may disturb the patient due to cosmetic concerns. One of the main factors affecting scar outcomes is probably the suture material used. The aim of this study was to examine the effect of different suture materials on scar outcomes of alar base in patients undergoing septorhinoplasty. Methods: Thirty-one patients who underwent alar base intervention during primary septorhinoplasty were divided into two groups according to the suture material used as the Polypropylene group (n = 16), (Polypropylene, Prolene 6/0; Ethicon Inc., Somerville, NJ, USA) and the Polyglactin group (n = 15), (Irradiated polyglactin 911, Vicryl RapidTM 6/0; Ethicon Inc., Somerville, NJ, USA). The scar outcomes of alar base were compared between the Polypropylene and Polyglactin groups. The modified Stony Brook Scar Evaluation Scale was used to measure wound healing results at one and 12-months postoperatively for objective evaluation. Patient satisfaction questionnaire was used for subjective evaluation. Results: There were no statistically significant differences in the Stony Brook Scar Evaluation Scale and patient questionnaire scores between Polypropylene and Polyglactin groups. Irradiated Vicryl Rapid had poor cosmetic outcomes in the alar base when compared to polypropylene, indicating no statistically significant difference. Conclusion: Both sutures can be used for closure of alar base considering their advantages and disadvantages, in patients undergoing septorhinoplasty. Level of evidence: Treatment Benefits; Level 2 (Randomized Trial).

Ventral and Inguinal Hernia Repair- Polyglactin - 910 better than Polypropylene?

Background: Mesh repair has been one of the most popular methods of hernia repair with the lowest recurrence rates as compared to other tissue repairs. With increasing incidence of incisional hernia which is only 2nd to inguinal hernia in incidence, number of surgeries performed for incisional hernia has increased considerably. The mesh fixation has traditionally been done with Polypropylene which are non-absorbable sutures. This study aims to compare the group of patients in which polyglactin-910 was used with patients in which polypropylene was used. Methods: The study is a prospective study conducted over a period of 4 years at the largest tertiary care hospital of Western India. 400 patients were included from which 256 patients had inguinal hernia and the rest 144 had ventral incisional hernias. Two groups were framed from these 400 patients – one in which polyglactin-910 was used (120 patients) and the other in which polypropylene (280 patients) was used. All the patients were followed up for at least 1 year and the complications were compared. Result: Out of 400 patients in 120 patients mesh repair was done with polglactin-910 and rest with poplypropylene, and study was conducted over a period of 4years with results showing incidence of pain 23% with poplypropylene against relatively low incidence with polyglactin-910 of 12%. Another observation was that incidence of sinus formation was 13% with polypropylene and only 0.8% with polyglactin-910. Conclusion: The study concluded that the association of pain and sinus formation was higher with polypropylene

Technique proposition and material comparison for surgery rope making / Proposição de técnica e comparação de materiais para confecção de corda cirúrgica

ABSTRACT: The most tension resistant, nonmetallic, surgical suture is 5 polyester. Comparing it's resistance to those of the dogs' cranial cruciate ligament and the canine gastrocnemius tendon's up until they rupture, it's possible to detect a considerably inferior resistance on the implant's part. With the goal of achieving high mechanical resistances from sutures, these were grouped and twisted, resulting in a surgical rope that is adjustable to the patients needs. We analyzed manufacturing methodology, final conformation and tension resistance, based on three sutures models: "A" (1 polyglactin 910), "B" (1 polyester) and "C" (5 polyester). Considering averages of thickness and final load, the "B" implants obtained lower values than "A", indicating that polyglactin 910 ropes are more resistant than those of polyester. Moreover, the "C" implants resulted in the highest values of load and thickness, indicating that final thickness is predictive towards tension resistance. Size 1 Polyester was the only one to generate linear regression for supported load, ensuring the 25,34 Newtons (N) increment to every suture added to the implant, which suggests its use for the creation of non absorbable ropes. The use of 1 polyglatctin 910 promotes load averages superior to 1 polyester;therefore, it is indicated for making absorbable surgical ropes.

RESUMO: O fio cirúrgico não metálico com maior resistência à tração é o poliéster nº 5. Comparando a sua resistência com a do ligamento cruzado cranial de cães e do tendão gastrocnêmico canino até suas rupturas, é possível perceber uma resistência consideravelmente inferior da parte do implante. Com objetivo de alcançar grandes resistências mecânicas a partir de fios de sutura, estes foram agrupados e torcidos, resultando em uma corda cirúrgica ajustável de acordo com a necessidade do paciente. Foram analisadas a metodologia de confecção, a conformação final e a resistência à tração, baseados em três modelos de fios: "A" (poliglactina 910 nº 1), "B" (poliéster nº 1) e "C" (poliéster nº 5). Considerando as médias de espessura e carga final, os implantes "B" obtiveram menores valores do que "A", indicando que cordas de poliglactina 910 são mais resistentes que as de poliéster. Ademais, os implantes "C" resultaram nos maiores valores de carga e espessura, indicando que a espessura final é preditiva para resistência à tração. O poliéster nº 1 foi o único a gerar regressão linear para carga suportada, garantindo o incremento de 25,34 Newtons (N) a cada fio acrescido ao implante, o que sugere seu uso para criação de cordas não absorvíveis. A utilização da poliglactina 910 nº 1 promove médias de carga superiores ao poliéster nº 1, portanto, é indicada para confecção de cordas cirúrgicas absorvíveis.

Surgical repair of traumatic rupture of superficial and deep digital flexor tendon in a 7 year old working mule with complicated skin injury

A 7 year old working mule,with the history of traumatic injury on left hind limb,was presented to TVCC within 6-7 hours of injury with open complicated skin wound. Physical and clinical examination revealed rupture of superficial and deep digital flexor tendons with relative soft tissue and skin damage. The case was diagnosed as traumatic flexor tendon rupture and posted for surgical correction by Bunnell-Mayer suturing technique. Anaesthesia was induced using Xylazine (1.1 mg/kg) and Ketamine (2.2 mg/kg) combination and maintained with thiopental sodium (500 mg) under lateral recumbency. Polyglactin-910 (#2) suture was preferred for tenorrhaphy because of higher tensile and functional strength. Post-operativeimmobilization was achieved by fiber-glass full limb cast. Animal showed lameness for the first post-operative week,and then slowly reduced. During the cast removal at 6thweek post-operatively, there was exuberant granulation tissue formation, which was removed by using cauterization.Thedressing of wound was continued with proper debridement and antibiotictill the re-establishment of damaged tissue

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.

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.

Evaluation of safety and efficacy of polyglactin 910 suture in surgical incision closure: clinical study protocol for a randomized controlled trial

Background: Surgical site infection (SSI) occurs in a considerable portion of patients after closure of surgical incision. The newer synthetic absorbable sutures consistently display proven advantages for wound healing over naturally derived suture. The study is planned to evaluate the safety and efficacy of MITSU™ Polyglactin 910 Suture with Coated Vicryl® Polyglactin 910 Suture in a closure of surgical incision.Methods: This is a prospective, multicentric, post-marketing, randomized, controlled, single-blinded, comparative study in a closure of surgical incision where general soft tissue approximation and/or ligation is required during an elective surgery. Patients are randomized to 1:1 ratio in the test (MITSU Polyglactin 910 Suture) and reference (Coated Vicryl Polyglactin 910 Suture) groups. Patients are monitored for safety and efficacy outcomes, viz. the rate of SSI, hospital length of stay, overall wound dehiscence and any adverse events/serious adverse events at post-procedural, 14 days, 30 days and 6 months of surgery. The rate of SSI for each group will be analyzed using one sided T-test. The effect of type of suture on SSI and overall wound dehiscence will be evaluated with chi-square test. Length of stay in hospital will be evaluated with student’s t-test.Conclusions: The study has been designed to compare the safety and efficacy of MITSU Polyglactin 910 Suture versus Coated Vicryl Polyglactin 910 Suture in a closure of surgical incision. Trial registration: The trial protocol has been registered with the clinical trial registry of India (CTRI/2017/01/007717; registered on 17/01/2017).

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.

A Comparative Evaluation of Absorbable and Nonabsorbable Sutures for Open Repair of Achilles Tendon Rupture: A Pilot Study / 체질인류학회지

This pilot study was performed to compare the functional and clinical results including complications after surgery in the open repair of Achilles tendon rupture with regard to the type of suture material. A consecutive series of twenty patients with acute Achilles tendon rupture who underwent open repair were enrolled in this pilot study. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The Korean version of the Foot and Ankle Outcome Score (FAOS) and complications were assessed to evaluate functional and clinical result. Mean total Foot and Ankle Outcome Score (FAOS) was 89.8 (range, 71.1~100) in the nonabsorbable suture group and 82.7 (range, 61.9~92.5) in the absorbable suture group (p=0.22). All patients returned to their previous life activity. The absorbable suture group had fewer postoperative complications (10%) than the nonabsorbable suture group (20%), but there was no significant difference between two groups (p=0.45). This pilot study showed that use of an absorbable suture for Achilles tendon repair had functional and clinical results comparable to those of the nonabsorbable suture. However, a use of an absorbable suture was associated with a lower incidence of complications than the use of nonabsorbable suture. Therefore, these results have to be confirmed in a randomized controlled cohort trial with larger population.

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.

Placing subcutaneous drain and preseting triclosan-coated polyglactin 910 suture with delayed suturing to prevent typeⅢabdominal surgery incision infection / 实用医学杂志

Objective To investigate the effect of placing subcutaneous drain tube and preseting triclosan-coated polyglactin 910 suture with delayed suturing to incision infection after typeⅢabdominal surgery. Methords Dividing 504 patients with typeⅢincisions undergone abdominal surgery into 3 groups. The number of group A patients with thoroughly incision washing and primary triclosan-coated polyglactin 910 suture after abdominal surgery was 143. The number of group B with closed anterior rectus sheath, opened skin and subcutaneous fat with preseted triclosan-coated polyglactin 910 suture was 190. The number of group C with subcutaneous drain tube after abdominal surgery was 171. We compared the incidence rates of incision infection and the second phase debridement suture rates among the 3 groups. Results For the group A, B, C, the number of incision infection people was 11, 4, 3 and the incision infection rate was 7.69%, 2.11%and 1.75%respectively. The difference of the 3 groups incision infection rate were statistically significant (P<0.05). The incision infection rate of the group B and group C were lower than that of group A and the difference were statistically significant (P<0.016 7). There were no significant differences in second phase debridement suture rates among the 3 groups. Conclusion Preseting triclosan-coated polyglactin 910 suture with delayed incision sutue and placing subcutaneous drain tube can decrease the incision infection rates for type Ⅲpatients after abdominal surgery, but can not decrease the second phase debridement suture rates of the infectious incision.

Evaluation of tensile strength of surgical synthetic absorbable suture materials: an in vitro study

PURPOSE: The purpose of this study was to evaluate the tensile strength of surgical synthetic absorbable sutures over a period of 14 days under simulated oral conditions. METHODS: Three suture materials (polyglycolic acid [PGA], polyglactin [PG] 910, and poly (glycolide-co-small je, Ukrainian-caprolactone) [PGC]) were used in 4-0 and 5-0 gauges. 210 suture samples (35 of each material and gauge) were used. All of the samples were tested preimmersion and 1 hour and 1, 3, 7, 10, and 14 days postimmersion. The tensile strength of each suture material and gauge was assessed. The point of breakage and the resorption pattern of the sutures were also assessed. RESULTS: During the first 24 hours of immersion, all 4-0 and 5-0 samples of PGA, PG 910, and PGC maintained their initial tensile strength. At baseline (preimmersion), there was a statistically significant (P<0.001) difference in the tensile strengths between the 4-0 and 5-0 gauge of PGA, PG 910, and PGC. PGA 4-0 showed the highest tensile strength until day 10. At 7 days, all the 4-0 sutures of the three materials had maintained their tensile strength with PGA 4-0 having significantly greater (P=0.003) tensile strength compared to PG. CONCLUSIONS: 4-0 sutures are stronger and have greater tensile strength than 5-0 sutures. The PGA 4-0 suture showed the highest tensile strength at the end of day 10.

Evaluation of the relative efficacy of copolymerized polylactic-polyglycolic acids alone and in conjunction with polyglactin 910 membrane in the treatment of human periodontal infrabony defects: A clinical and radiological study.

Background: Absorbable synthetic biopolymers have been used as bone filler in Periodontology, proving effective stimulants to bone regeneration. Aim: Copolymerized polylactic and polyglycolic acid is used as a bone filler and polyglactin 910 as a guided tissue regeneration (GTR) membrane to achieve regeneration in periodontal infrabony defects. Materials and Methods: Forty patients with two- or three-walled infrabony defects were selected and randomly divided into two groups. Group A included patients treated with polylactic-polyglycolic acids 50:50 (Fisiograft® ,Ghimsa SPA,Via Fucini, Italy) alone and Group B included patients treated with polylactic-polyglycolic acids (PLA-PGA)50:50 in conjunction with polyglactin acid 910 (Vicryl Mesh® Johnson&Johnson , U.S.A ). Evaluation of clinical parameters probing depth and attachment level and radiographs was done preoperatively and 12 and 24 weeks postoperatively. Results: Both the groups showed statistically significant mean reduction in probing depth and gain in clinical attachment level and linear bone fill. Conclusions: Within the limit of this study, both the treatment modalities are beneficial for the treatment of infrabony defects.

Comparison of Fibrin Glue and Sutures for Conjunctival Wound Closure in Strabismus Surgery

PURPOSE: To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery. METHODS: In a prospective trial, we performed strabismus surgery using limbal incisions. Conjunctival wounds were closed with fibrin glue in 20 eyes of 20 patients (fibrin group) and 8-0 polyglactin suture in 20 eyes of 20 patients (suture group). Postoperative pain, tearing, and inflammation were compared at 1 day, 1 week, 3 weeks, and 6 weeks after surgery. Conjunctival incision healing was also investigated. RESULTS: One day and one week post-operatively, pain and tearing scores were lower in the fibrin group (p = 0.000, respectively). Mean surgery time was significantly shorter in the fibrin (48 +/- 5 minutes) than the suture group (63 +/- 7 minutes) (p = 0.000). Inflammation was significantly more severe in the suture group until 3 weeks postoperative (p = 0.000, respectively), but conjunctival healing did not differ between the groups. Hyperemia appeared more prominent in the fibrin group 3 and 6 weeks after surgery (p = 0.087 and 0.000, respectively). Two eyes in the fibrin group showed conjunctival gaps of more than 2 mm, which closed spontaneously by three weeks after surgery. No allergic reactions or infections developed. CONCLUSIONS: Fibrin glue proved to be as effective as sutures in closing conjunctival wounds. It provides more comfortable early postoperative courses and might be considered as an alternative to sutures in strabismus surgery.

Analysis of Infections Occurring in Breast Cancer Patients after Breast Conserving Surgery Using Mesh / 한국유방암학회지

PURPOSE: Breast conserving surgery using mesh can effectively fill the defective space, but there is the risk of infection. METHODS: From June 2007 to August 2010, 243 patients who underwent breast conserving surgery with polyglactin 910 mesh insert for breast cancer at our institution were retrospectively studied. RESULTS: Infection occurred in 25 (10.3%) of 243 patients. When comparing the infection and non-infection groups in multivariate analysis, there was no significant difference in age, underlying disease, preoperative biopsy methods, mass location, axillary lymph node dissection, operative methods, neoadjuvant or adjuvant chemotherapy use, mass size and removed breast volume. The infection appeared more common only in patients with body mass index (BMI) greater than 25. Infection symptoms occurred, on average, 119.5 days after surgery, and the average duration of the required treatment was 34.4 days. Out of 25 patients with postoperative infection complications, 16 (64%) patients underwent incision and drainage with mesh removal, whereas the remaining 9 (36%) only required conservative treatment. CONCLUSION: During breast conserving surgery, the risk of infection is increased in patients with high BMI, and should be taken into account when considering insertion of a polyglactin 910 mesh. Patient's age, underlying disease and perioperative treatment methods were not significant risk factors for developing mesh infection. Given that most infections seem to develop symptoms one month after surgery, a long enough observation period should be initiated. Early detection and appropriate conservative treatments may effectively address infections, thus reducing the need for more invasive therapies.

Cut and paste: A novel method of re-attaching rectus muscles with cyanoacrylate during recessions in strabismus.

Aim: Bio-adhesives like cyanoacrylate offer an alternative to sutures to attach tissues, including in ophthalmology. This prospective trial evaluated the suitability and bio-tolerance of iso-amyl cyanoacrylate in rectus muscle recession surgery for strabismus. Materials and Methods: We randomized one eye in each of 10 cases of bilateral horizontal rectus recessions to 6/0 polyglactin and the other to iso-amyl-cyanoacrylate. We compared time to reattachment (from disinsertion), complications and inflammatory scores (0 to +3: nil, mild, moderate and severe) on Day One, at two and at four to six weeks post surgery. Results: There were no significant group differences in inflammatory scores (Wilcoxon, all values of P>0.05). All attachments held firm. Gluing took significantly longer by 5.24±1.91 min (95% CI for difference: 3.87-6.61). There were no complications. Conclusion: We feel that although it takes marginally longer, iso-amyl cyanoacrylate offers an effective and safe alternative to sutures for muscle recession in strabismus surgery. Since it is cheaper (vs. polyglactin) and offers multi-use possibility it may also prove to be cost-effective.

Volume Replacement with Polyglactin 910 Mesh for Breast Reconstruction after Endoscopy-Assisted Breast Conserving Surgery for Treating Early Breast Cancer: the Early Results / 한국유방암학회지

PURPOSE: We introduce a new technique using a Vicryl(R) mesh made with Polyglactin 910 for breast reconstruction after performing endoscopy-assisted breast conserving surgery. METHODS: From July 2006 to July 2008, we performed endoscopiy-assisted breast surgery in 30 patients with early breast cancer. (Thirty [fourteen] patients [who] underwent endoscopy-assisted breast conserving surgery). Of the total patients, 14 underwent reconstruction procedure (volume replacement with the use of a Vicryl(R) mesh) and 16 underwent reconstuction without Vicryl(R) mesh. We were evaluated for their quality of life (QOL), the surgery-related complications and the cosmetic outcomes. Three patients were excluded from the study; two patients required mesh removal due to infection and the other patient had a total mastectomy performed due to a positive resection margin. RESULTS: The median age of the patient was 49.4 year (range 36-60 year) and all of the patients had a diagnosis of early breast cancer (less than stage IIb). In general, the patients were satisfied with the outcome for their QOL. The patients were especially satisfied with the cosmetic outcome. The patients' satisfaction increased with longer follow-up, as compared to that for the shorter intervals. At 10 months after surgery, there was encapsulated granulation tissue within a collection of tissue fluid, as seen on ultrasonography. At 20 months after surgery, the skin and breast shape both recovered. CONCLUSION: The results of this study showed that for relatively short follow-up period, breast reconstruction with using Polyglactin 910 mesh, which is made from oxidized regenerated cellulose, resulted in satisfactory cosmetic results and a good quality of life after breast conservative surgery.

Comparison of 2-Octylcyanoacrylate and Suture with 8-0 Polyglactin for Conjunctival Wound Closure in Rabbits

PURPOSE: To evaluate the clinical efficacy and the histopathologic tolerance of 2-octylcyanoacrylate versus 8-0 polyglactin sutures for conjunctival wound closure in rabbits. METHODS: We performed an experimental study on 16 eyes of eight New Zealand albino rabbits. Conjunctival peritomy of 8 mm was done in the superior limbus followed by extensive subconjunctival dissection in both eyes. The eyes of the rabbits were divided into two groups. The conjunctiva was then attached to the limbus again by the proposed 2-octylcyanoacrylate adhesive (left eye, Group A) or 8-0 polyglactin suture (right eye, Group B). The clinical efficacy of the closure of the conjunctival wound, either with sutures or adhesives, and the clinical and histopathologic tolerances such as hyperemia, discharge, residual adhesive or suture, inflammatory change and fibrosis were observed at 1 day and at 1, 2, 4 and 6 weeks after surgery. Two rabbits were sacrificed at each of 1, 2, 4 and 6 weeks, and specimens of their conjunctiva were examined histologically. RESULTS: Both conjunctival surgical closure methods were found to be equally efficacious in fixing the conjunctiva to the limbus. There were no significant clinical or histopathologic tolerance differences between the two groups. The conjunctiva at 6 weeks of Group A showed nearly normalized morphology with disappeared inflammatory cells and fibroblasts, whereas those of Group B showed foreign body inflammatory reaction around the absorbing suture materials. CONCLUSIONS: 2-Octylcyanoacrylate adhesive was an efficient conjunctival closure method and was very well tolerated by the ocular surface. 2-Octylcyanoacrylate may be a possible tissue adhesive for conjunctival wound closure.

Estudio de la degradación hidrolítica de un copolímero biodegradale / Study of the hydrolytic degradation of a biodegradable copolymer

Se estudió la degradación hidrolítica in vitro de suturas de Poliglactin 910 utilizando un buffer de fosfato , pH= 7,4, a 37 °C. La degradación fue evaluada a través de la perdida en peso, cambio en las propiedades térmicas, morfología y propiedades mecánicas de las suturas sometidas a hidrólisis. Después de 10 semanas, los resultados obtenidos de la pérdida en peso y pH sugieren la difusión de especies de bajo peso molecular al medio de reacción como consecuencia del ataque hidrolítico a los grupos éster en el polímero. La disminución de las propiedades mecánicas, tanto el esfuerzo de ruptura como el modulo, junto con los resultados anteriores sugieren que el proceso de escisión de cadenas procede en dos etapas: la primera ocurre en las zonas amorfas y la segunda en las zonas cristalinas. El estudio de la morfología correspondiente a la superf icie de las sutura revela un mecanismo de degradación heterogéneo por capas.

The hydrolytic degradation of bioabsorbable Poliglactin 910 was studied in a phosphate buffer solution, pH= 7,4, at 37 °C. The degradation was evaluated by analyzing the changes in weight loss, pH, DSC, mechanical properties and morphological changes. After 10 weeks, the weight loss and pH changes suggested diffusion of low molecular weight chain segments into the reaction medium as a consequence of the breaking of ester bonds in the material. Breaking stress and Young Modulus decrease, indicating that chain scission proceeded in two steps: the first ocurring in the amorphous regions within the intermicrofibrillar space; the second in the crystalline regions. Surface morphological changes suggest a heterogeneous degradation mechanism by layers.