Absorbable suture. Best aesthetic outcome in cesarian scar

Abstract Purpose: To compare two suture threads, poliglecaprone 25 and nylon, used as intradermal suture for skin closure in women undergoing their first cesarean section. Methods: This is a randomized clinical trial. A total of 60 women undergoing their first cesarean section were enrolled and prospectively assessed. They were randomly allocated to group I (n=30), which received an intradermal suture with nylon 4.0 or to group II (n=30), which had an intradermal suture with poliglecaprone 25, 4.0. The main author took standardized photographs of the scar 6 months after the operation. Four independent raters, two senior obstetricians and two senior plastic surgeons (a male and a female physician from each specialty) assessed the photographs.The panelists rated the scar according to Trimbos scale, composed by the subscales hypertrophy, color and width of the scar. Results: At baseline, patients in both groups were similar regarding age and body mass index. Five patients withdraw the study, four from group and one from group II. Scars of patients from group II were significantly less hypertrophic (p=0.001), thinner (p=0.019) and had more acceptable color (p=0.019). Conclusion: The intradermal suture with poliglecaprone 25 for skin closure after cesarean incision provides better aesthetic result.

Comparison of two different suture techniques in laparoscopic partial nephrectomy

ABSTRACT Objective: To comparatively evaluate the traditional interrupted knot-tying and running suture renorrhaphy with Monocryl® in laparoscopic partial nephrectomy (LPN). Materials and Methods: A retrospective analysis of 62 consecutive patients undergoing LPN using traditional interrupted knot-tying suture renorrhaphy (Group 1; n=31) or running suture technique renorrhaphy with 2-0 monofilament polyglecaprone (Monocryl®, Ethicon) (Group 2; n=31) from December 2011 to October 2015 at the University. All patients underwent LPN performed by an experienced laparoscopic surgeon. The demographic, perioperative and postoperative parameters were compared between the groups, and the effect of both suture techniques on the warm ischemic time (WIT) and trifecta were evaluated. Results: The running suture renorrhaphy with Monocryl® reduced WIT, estimated blood lost and length of hospitalization stay significantly without increasing postoperative complication rate during LPN in comparison with interrupted knot-tying suture. Conclusion: The renorrhaphy using the running suture with Monocryl® is an effective and safe technique with the advantage of shortening WIT even in more challenging and larger tumors during LPN.

Characteristics of the fibroplasia and collagen expression in the abdominal wall after implant of the polypropylene mesh and polypropylene/polyglecaprone mesh in rats

ABSTRACT PURPOSE: To compare fibroplasia and the resistance of the abdominal wall when polypropylene meshes and polypropylene/poliglecaprone are used. METHODS: Seventy-seven male Wistar rats were divided into three groups: Control Group (for resistance); Group E (polypropylene mesh); and Group U (polypropylene/poliglecaprone mesh). The animals in Groups E and U had a standard muscular and aponeurotic defect, with integral peritoneum, and correction with the mesh. Measurements were taken 4, 7, 14, 28 and 56 days after surgery. The resistance, and collagen density were studied. RESULTS: Resistance on the 56th day was similar in both meshes. The gain in resistance described an ascending curve for the polypropylene mesh and was irregular in the case of the polypropylene/poliglecaprone. Fibroplasia showed a gain in type I and type III collagen in both groups (p<0.001). Collagen III stabilized in the 14th day and collagen I continued to ascend. CONCLUSIONS: The gain in resistance of the polypropylene mesh is regular and ascending, whereas the polypropylene/poliglecaprone is not regular. The final resistance of both meshes is similar; the collagen density increases over time, and show the same inflammatory potential.

Polypropylene and polypropylene/polyglecaprone (Ultrapro(r)) meshes in the repair of incisional hernia in rats

PURPOSE: To compare the inflammatory response of three different meshes on abdominal hernia repair in an experimental model of incisional hernia. METHODS: Median fascial incision and skin synthesis was performed on 30 Wistar rats. After 21 days, abdominal hernia developed was corrected as follows: 1) No mesh; 2) Polypropylene mesh; and, 3) Ultrapro(r) mesh. After 21 days, the mesh and surrounding tissue were submitted to macroscopic (presence of adhesions, mesh retraction), microscopic analysis to identify and quantify the inflammatory and fibrotic response using a score based on a predefined scale of 0-3 degrees, evaluating infiltration of macrophages, giant cells, neutrophils and lymphocytes. RESULTS: No significant difference was seen among groups in adherences, fibrosis, giant cells, macrophages, neutrophils or lymphocytes (p>0.05). Mesh shrinkage was observed in all groups, but also no difference was observed between polypropylene and Ultrapro mesh (7.0±9.9 vs. 7.4±10.1, respectively, p=0.967). Post-operatory complications included fistula, abscess, dehiscence, serohematic collection and reherniation, but with no difference among groups (p=0.363). CONCLUSION: There is no difference between polypropylene (high-density) and Ultrapro(r) (low-density) meshes at 21 days after surgery in extraperitoneal use in rats, comparing inflammatory response, mesh shortening, adhesions or complications. .

In Vivo Effects of Adipose-Derived Stem Cells in Inducing Neuronal Regeneration in Sprague-Dawley Rats Undergoing Nerve Defect Bridged with Polycaprolactone Nanotubes

There have been many attempts for regeneration of peripheral nerve injury. In this study, we examined the in vivo effects of non-differentiated and neuronal differentiated adipose-derived stem cells (ADSCs) in inducing the neuronal regeneration in the Sprague-Dawley (SD) rats undergoing nerve defect bridged with the PCL nanotubes. Then, we performed immunohistochemical and histopathologic examinations, as well as the electromyography, in three groups: the control group (14 sciatic nerves transplanted with the PCL nanotube scaffold), the experimental group I (14 sciatic nerves with the non-differentiated ADSCs at a density of 7x105 cells/0.1 mL) and the experimental group II (14 sciatic nerves with the neuronal differentiated ADSCs at 7x105 cells/0.1 mL). Six weeks postoperatively, the degree of the neuronal induction and that of immunoreactivity to nestin, MAP-2 and GFAP was significantly higher in the experimental group I and II as compared with the control group. In addition, the nerve conduction velocity (NCV) was significantly higher in the experimental group I and II as compared with the control group (P=0.021 and P=0.020, respectively). On the other hand, there was no significant difference in the NCV between the two experimental groups (P>0.05). Thus, our results will contribute to treating patients with peripheral nerve defects using PCL nanotubes with ADSCs.

Artroplastia glenoumeral: resistência do fio de poliéster após contato com o metilmetacrilato / Glenoumeral arthroplasty: polyester properties after methyl methacrylate contact

OBJETIVO: Os autores estudam as características do fio de poliéster (ethibond) após o contato com o metilmetacrilato (cimento ortopédico) no laboratório de resistência de materiais. MÉTODOS: Avaliam a força necessária para a ruptura bem como a elasticidade e a deformidade provocadas durante a tração no aparelho Instron 4482. Realizam análise estatística através do teste "t-student". RESULTADOS: Não encontram diferença estatisticamente significativa entre os grupos estudados. CONCLUSÃO: Concluem que o contato do metilmetacrilato com o poliéster não acarreta mudanças na suas propriedades elásticas e de resistência à tração.

OBJECTIVE: The authors studied the physical properties of polyester thread (ethibond) following methyl methacrylate contact in a biomechanics laboratory. METHODS: Strain at rupture, elasticity and traction deformity were evaluated using an Instron 4482 machine. The student-t test was used for the statistical analysis. RESULTS: There were no statistical differences between the two groups. CONCLUSION: It is concluded that methy metacrylate contact with polyester does not affect its elastic properties and traction resistance.

Comparison of efficacy of 1% silver sulfadiazine and Acticoat for treatment of partial-thickness burn wounds.

BACKGROUND: Acticoat (Smith & Nephew, Hull, UK) is a silver-coated dressing reported to reduce infection and exhibit antimicrobial activity in wounds. OBJECTIVE: The purpose of the present study was to compare the efficacy ofacticoat and 1% silver sulfadiazine (1% AgSD) for treatment of partial thickness burn wounds. MATERIAL AND METHOD: The authors reviewed 50 patients who had partial thickness burn wounds less than 25% admitted to Siriraj Burn Unit from May 2002 to September 2005. All patients were divided into 2 groups: the acticoat treated group (25 patients) and the 1% silver sulfadiazine treated group (25 patients). The 2 groups were compared for the etiology of burn wound, demographic data including age, sex, % Total Body Surface Area burn (TBSA%), cultured organisms, wound infection and outcome of Length Of hospital Stay (LOS) and level of pain. RESULTS: The authors found no significant differences in age, TBSA (%) between both groups. 7 patients (28%) developed wound infection. There were no differences in wound infection and LOS between both groups (p > 0.05). All of the patients who developed wound infection responded well to targeted topical and systemic antibiotic treatment. The 1% AgSD treated group (6 of 25, 24%) obtained more split thickness skin graft to close the granulation defects compared to patients who were treated with acticoat (4 of 25, 16%) but no statistical significance, p = 0.32). Average pain scores in the acticoat treated groups were significantly lower than the 1% AgSD treated group (4 +/- 0.6 versus 5 +/- 0.7, respectively). CONCLUSION: The present study confirms the efficacy of acticoat treatment in partial thickness burn wound. The authors conclude that acticoat has an advantage of limiting the frequency of replacement of the dressing and provides a less painful alternative to wound care with 1% AgSD with comparable incidence of burn wound infection. This is due to its long wear time and the ease of application and removal.

Reconstruçäo das polias digitais anulares com material sintético: estudo experimental em coelhos / Reconstruction of the digital annular pulleys with synthetic material: experimental study in rabbits

A reconstruçäo das polias digitais anulares com o uso de uma polia artificial tecida em fios de poliéster trançado, semelhante ao uso para fazer ligamentos artificiais para procedimentos reconstrutivos do joelho (Artrolig), foi estudada num modelo experimental. Foram operados 24 coelhos machos da raça Nova Zelância, distribuídos em três grupos conforme o período de observaçäo pós-operatória, de 4, 8 e 12 semanas; um animal em cada grupo foi utilizado como controle, para estudo da polia digital natural intocada. O aparelho flexor digital da garra correspondente ao dedo anular de humanos das patas dianteiras direitas era abordado através de uma incisäo médio-lateral; a polia sobre a falange proximal era ressecada, deixando um coto de cerca de 2mm de cada lado do canal flexor e a polia artificial era suturada de cada lado, sobre o tendao íntegro. Os resultados foram avaliados por meio de estudos macroscópicos e histológicos. Ao exame macroscópico dos espécimes, observou-se em todos os grupos a formaçäo de uma capa fibrosa ao redor da polia artificial, que impedia quase completamente o deslizamento dos tendöes. Ao exame histológico, observou-se que a capa era formada por tecido fibroso de maturaçäo progressiva, cujas fibras foram lentamente orientando-se no sentido transversal ao eixo de deslizamento do tendäo entremeadas com as fibras da polia artificial e dispondo-se ao seu redor de forma helicoidal. Havia, ainda, infiltrado inflamatório ao redor da neopolia, mas pouco exuberante e de caráter regressivo com o tempo, näo tendo sido observada a formaçäo de reaçöes de corpo estranho em nenhum grupo. Näo se observou a definiçäo de um espaço, nem de um tecido de características mesoteliais, na interface neopolia-tendäo. Concluiu-se que a formaçäo da capa fibrosa ao redor da neopolia e do tendäo deveu-se a agressäo mecânica do material, mas a ausência de reaçäo de corpo estranho indicou a biocompatibilidade do material, o qual, todavia, na forma estudada, foi inadequada para a reconstruçäo das polias digitais anulares.

Poliglecaprone-25, sutura de monofilamento absorbible: experiencia en 110 pacientes / Polyglecaprone-25, absorbable monofilament suture: experience in 110 patients

Objetivo: Evaluar en pacientes la sutura de monofilamento absorbible denominada poliglecaprone-25. Esta sutura es un producto de la investigación química de los poliésteres y mantiene la fuerza tensil adecuada a 20 días y se absorbe por hidrólisis en 90 a 120 días. Diseño: Estudio prospectivo, longitudinal. Sitio: En varios servicios de Cirugía del Hospital de Especialidades del Centro Médico Nacional del IMSS y en varios hospitales privados. Pacientes y método: Se estudiaron 110 pacientes bajo un protocolo; los cirujanos calificaron diversas variables como la facilidad de maniobra y paso por los tejidos, la presencia o no de memoria, la seguridad del nudo y la visibilidad. Los pacientes fueron evaluados en los primeros 30 días sin encontrar efectos adversos por la sutura. La calificación de variables fue del 1 al 5, considerándose el número mayor para los resultados. Resultados: En general la sutura alcanzó una calificación de 4.66 en promedio; cuando se analizó la visibilidad en el campo operatorio descendió a 3, en especial con suturas menores a 2-0. Conclusiones: El poliglecaprone-25 es una sutura de material monofilamento absorbible útil en múltiples intervenciones quirúrgicas

Reconstruçäo do ligamento cruzado anterior: utilizaçäo do ligamento sintético ABC / Reconstruction of the anterior cruciate ligament: use of the ABC synthetic ligament

Os autores apresentam 26 casos revistos de reconstruçäo do ligamento cruzado anterior (LCA) em que se utilizam tanto nas instabilidades agudas quanto nas crônicas, o ABC - Active Bioprosthetic Composite -, um ligamento, sintético, composto de fibras de carbono e poliéster. Os pacientes foram operados no Hospital de Tráumato-Ortopedia do Rio de Janeiro (HTO-RJ), no período de dezembro de 1989 a outubro de 1991, sendo 22 do sexo masculino e quatro do feminino, com idade média de 34,5 anos. Concluem os autores que, embora a avaliaçäo dos resultados com esta técnica seja precoce, a substituiçäo do LCA pelo ligamento ABC se configura como uma alternativa para o tratamento dessas lesöes. Sem dúvida, novas investigaçöes e um tempo maior de acompanhamento fazem-se necessários para que se obtenham melhores conclusöes

Fixaçäo mecânico-biológica de ligamentos artificiais (próteses artificiais de partes moles): apresentaçäo de uma técnica original a partir de estudo imediato e a curto prazo em ovelhas / Mechanico-biological of artificial ligaments (artificial prosthesis of soft parts): presentation of an original technical as from of immediate and short term study in sheeps

Através de trabalho prospectivo, os autores estudaram em ovelhas o comportamento de cinco técnicas de fixaçäo de próteses ligamentares ao nível do joelho. Para tanto, foram utilizados critérios biomecânicos, radiológicos e histológicos. O tempo global e evoluçäo do projeto foi de dois anos, sendo que, na etapa in vivo, as ovelhas foram sacrificadas após três semanas, quatro meses e sete meses. Esses resultados foram comparados, quanto à resistência à traçäo, com o resultado preliminares obtidos em joelhos de ovelhas abatidas poucas horas antes dos testes. Dos métodos investigados, a fixaçäo com grampo metálico foi a menos eficaz, sendo o conjunto mecânico-biológico (parafuso + arruela metálica + arruela óssea) o que nos pareceu mais satisfatório