Optimal suture materials for contaminated gastrointestinal surgery: does infection influence the decrease of the tensile strength of sutures?
OBJECTIVE
Suture materials are selected based on the following factors: absorbable/non-absorbable, monofilament/multifilament, duration with sufficiently high tensile strength, and the tissue to be sutured. Absorbable sutures are hydrolyzed in tissues. However, little is known about the influence of infection on the hydrolysis and decrease in the tensile strength.


METHODS
Four kinds of sutures, i.e., non-absorbable multifilament silk, non-absorbable monofilament polypropylene (Prolene(®)), absorbable multifilament polyglactin 910 (Vicryl(®)), and absorbable monofilament polydioxanone (PDS(®)) were implanted in the back of rats. A suspension of Escherichia coli + Bacteroides fragilis or saline was injected subcutaneously into the contaminated and clean condition groups, respectively. The sutures were removed 1, 2, 4 or 8 weeks after the implantation.


RESULTS
There was significantly more severe inflammation macroscopically for the silk sutures under the contaminated conditions (p = 0.03), however, no significant differences were observed among the other three sutures. All 4 kinds of sutures showed a reduction of the tensile strength over time. There were no significant differences in the magnitude of reduction between both the clean and contaminated conditions for any of the sutures.


CONCLUSIONS
The reduction of the tensile strength with time did not differ significantly between sutures exposed to contaminated and clean conditions, even for the absorbable sutures.
Department of Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
Yoichi
Y
Tanaka
Sotaro
S
Sadahiro
Kenji
K
Ishikawa
Toshiyuki
T
Suzuki
Akemi
A
Kamijo
Seiki
S
Tazume
Masanori
M
Yasuda
D000818:Animals; D001672:Biocompatible Materials / Q000009:adverse effects* / Q000145:classification*; D013505:Digestive System Surgical Procedures / Q000295:instrumentation*; D004195:Disease Models, Animal; D005260:Female; D005759:Gastroenteritis / Q000209:etiology; D007249:Inflammation / Q000209:etiology; D008422:Materials Testing; D016687:Polydioxanone; D011091:Polyesters; D011098:Polyglactin 910; D011108:Polymers; D011126:Polypropylenes; D051381:Rats; D017208:Rats, Wistar; D047011:Silk; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D013537:Sutures / Q000009:adverse effects* / Q000145:classification*; D013718:Tensile Strength
D001672:Biocompatible Materials; D011091:Polyesters; D011108:Polymers; D011126:Polypropylenes; D047011:Silk; D016687:Polydioxanone; D011098:Polyglactin 910