Effect of chemotherapy and heat on biomechanical properties of absorbable sutures.
BACKGROUND
The quality of tissue repairs depends on tissue integrity, surgical technique, and material properties of the sutures used. Currently, there is no clear consensus on which is the best suture to use during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. The aim of this study was to evaluate the impact of heat and chemotherapy on sutures' biomechanical properties.


METHODS
Six different 3.0 absorbable sutures (Biosyn, Dexon II, Maxon, Monocryl, PDS II, and Vicryl Plus) were tested. All suture strands were incubated for a 24-h period in saline, mitomycin-c, and oxaliplatin at 37 and 45°C. Suture loops were then loaded to failure using a servohydraulic testing machine. Data for tensile breaking force (TBF) and elongation rate were collected for all samples.


RESULTS
Under basal condition, Maxon was the strongest of all sutures with a TBF of 59.6 ± 4.3 N (P < 0.01), and no significant difference in TBF was observed between other sutures. Heat alone had no impact on sutures' biomechanical parameters. Exposition to mitomycin-c at 45°C did not significantly affect sutures' basal tensile properties, with Maxon remaining the strongest suture. When incubated in oxaliplatin at 45°C, the six suture types had a similar TBF. In all experimental conditions, multifilament sutures had a significantly lower elongation rate than monofilament sutures, and no correlations were demonstrated between elongation rate and the TBF of sutures.


CONCLUSIONS
This study showed that exposition to heated chemotherapy did not significantly affect absorbable sutures biomechanical properties.
Division of General Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
Stéphanie
S
Lapointe
Department of Biomedical Engineering, École Polytechnique de Montréal, Université de Montréal, Montréal, Québec, Canada.
Fouad
F
Zhim
Division of General Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
Lucas
L
Sidéris
Department of Anesthesiology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
Pierre
P
Drolet
Division of General Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
Syndie
S
Célestin-Noël
Division of General Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada. Electronic address: pierredube@videotron.qc.ca.
Pierre
P
Dubé
D020341:Absorbable Implants; D000970:Antineoplastic Agents / Q000494:pharmacology*; D001672:Biocompatible Materials; D006358:Hot Temperature / Q000009:adverse effects*; D016685:Mitomycin / Q000494:pharmacology; D009944:Organoplatinum Compounds / Q000494:pharmacology; D000077150:Oxaliplatin; D013537:Sutures; D013718:Tensile Strength / Q000187:drug effects*; D016474:Weight-Bearing
D000970:Antineoplastic Agents; D001672:Biocompatible Materials; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D016685:Mitomycin
Absorbable sutures; Elongation rate; HIPEC; Mitomycin-C; Oxaliplatin; Tensile strength