title: New suture materials for midline laparotomy closure: an experimental study.
abstract: BACKGROUND
  Midline laparotomy closure carries a significant risk of incisional hernia. This study examines the behavior of two new suture materials, an elastic material, polyurethane (PUe), and a barbed polydioxanone (PDXb) suture thread in a rabbit model of midline incision closure.
  
  
  METHODS
  Three 2-cm midline incisions were made in 68 New Zealand White rabbits. The incisions were closed by running suture using four 3/0 threads: polypropylene (PP) (Surgipro®, Covidien), PUe (Assuplus®, Assut Europe), PDX (Assufil®, Assut Europe) or PDXb (Filbloc®, Assut Europe). Animals in each suture group were euthanized 3 weeks and 6 months after surgery. Histological sections of the tissue-embedded sutures were subjected to morphological, collagen expression, macrophage response and uniaxial tensiometry studies.
  
  
  RESULTS
  No signs of wound dehiscence or complications were observed. At 3 weeks, all sutures were surrounded by connective tissue composed mainly of collagen III. PUe showed greater collagen I expression than the other sutures. All sutures elicited a macrophage response that diminished from 3 weeks to 6 months (p < 0.001). This response was similar for the non-reabsorbable sutures (PP and PUe) yet PDXb showed a significantly greater response than the other reabsorbable suture (PDX) at 3 weeks (p < 0.01). At this early time point, the tensile strength of PUe was similar to that of control intact tissue (p > 0.05).
  
  
  CONCLUSIONS
  Three weeks after surgery, PUe revealed more collagen I deposition than the remaining materials and this translated to a similar biomechanical behavior to linea alba, that could avoid the appearance of short term dehiscences and thus reduce the incidence of incisional hernia. PDXb provides no additional advantages in their behavior regarding PDX suture.
authors.affiliation: Departments of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain. juanm.bellon@uah.es.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Bellón
authors.forename: Paloma
authors.initials: P
authors.lastname: Pérez-López
authors.forename: Raquel
authors.initials: R
authors.lastname: Simón-Allue
authors.forename: Sandra
authors.initials: S
authors.lastname: Sotomayor
authors.forename: Bárbara
authors.initials: B
authors.lastname: Pérez-Köhler
authors.forename: Estefanía
authors.initials: E
authors.lastname: Peña
authors.forename: Gemma
authors.initials: G
authors.lastname: Pascual
authors.forename: Begoña
authors.initials: B
authors.lastname: Calvo
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D046449:Hernia, Abdominal / Q000517:prevention & control*; D007813:Laparotomy / Q000379:methods*; D008422:Materials Testing; D011817:Rabbits; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013718:Tensile Strength; D014945:Wound Healing