Doxycycline-coated sutures improve mechanical strength of intestinal anastomoses.
OBJECTIVE
After resection and repair of the intestines, tissue degradation leads to weakening of the repair site and risk of postoperative leakage. Matrix metalloproteinases (MMPs) are thought to be responsible for collagenolysis in the direct vicinity of surgical sutures in many tissues. Several experimental studies show that MMP inhibitors administered systemically alleviate postoperative weakening of intestinal anastomoses. We hypothesised that local delivery of MMP inhibitors would achieve a similar effect.


METHODS
Implementing a novel method for the coating of biomaterials, we coated sutures with a cross-linked fibrinogen film and bound the MMP inhibitor doxycycline into this film. The sutures were then used in a standard rat model for evaluating mechanical properties of colonic anastomoses 3 days after surgery.


RESULTS
The breaking strength of the anastomoses on the critical third day after operation was 17% higher with doxycycline-coated sutures compared to controls (P = 0.026). Energy uptake at failure was enhanced by 20% (P = 0.047).


CONCLUSIONS
Drug delivery by means of MMP-inhibitor-coated sutures appears to improve tissue integrity during anastomotic repair and may reduce postoperative complications.
Division of Orthopaedics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Björn
B
Pasternak
Martin
M
Rehn
Line
L
Andersen
Magnus S
MS
Agren
Anne-Marie
AM
Heegaard
Pentti
P
Tengvall
Per
P
Aspenberg
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D020099:Coated Materials, Biocompatible; D003106:Colon / Q000601:surgery*; D004195:Disease Models, Animal; D004318:Doxycycline / Q000494:pharmacology*; D004867:Equipment Design; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013718:Tensile Strength; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D004318:Doxycycline