title: Decreased Bacterial Adherence, Biofilm Formation, and Tissue Reactivity of Barbed Monofilament Suture in an In Vivo Contaminated Wound Model.
abstract: Monofilament and barbed monofilament sutures have been shown in in vitro models to have less bacterial adherence than braided suture. This study evaluates bacterial adherence to suture materials and tissue reactivity with an in vivo contaminated wound mouse model.
  
  
  
  Staphylococcus aureus was used to create an in vivo contaminated wound model at 2 amounts (106colony-forming units [CFU] and 108CFU) using a mouse air pouch. Three types of commonly used absorbable suture were evaluated: braided, monofilament, and barbed monofilament. Bacterial suture adherence was evaluated with suture culture, a photon-capturing camera system, and scanning electron microscopy. Tissue reactivity was assessed through histology and protein expression.
  
  
  
  The braided suture group with the high amount of S aureus exhibited frank purulence and air pouch hypertrophy in all 8 mice. A significant difference was found between suture groups inoculated with 108CFU (P < .05) as measured by bacterial culture concentration using the optical density method. The braided suture hosted more bacteria than either monofilament (P < .005) or barbed monofilament suture (P < .005). No difference was appreciated between the monofilament and barbed monofilament groups. Kruskal-Wallis test demonstrated a significant difference between groups in regard to levels of tumor necrosis factor-α (P < .05) and interleukin-1 (P < .05).
  
  
  
  Our in vivo contaminated wound model demonstrated that barbed monofilament suture performed similarly to monofilament suture and better than braided suture in terms of bacterial adherence, biofilm formation, and tissue reactivity.
authors.affiliation: Detroit Medical Center/Providence Hospital Orthopaedic Surgery Residency Program, Detroit, Michigan.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Morris
authors.affiliation: Department of Orthopaedic Surgery, Providence Hospital, Southfield, Michigan.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bergum
authors.affiliation: Department of Orthopaedic Surgery, Providence Hospital, Southfield, Michigan.
authors.forename: Nancy
authors.initials: N
authors.lastname: Jackson
authors.affiliation: Department of Orthopaedic Surgery, Providence Hospital, Southfield, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Markel
mesh_terms: D000818:Animals; D001422:Bacterial Adhesion; D018441:Biofilms; D005260:Female; D007375:Interleukin-1 / Q000378:metabolism; D008807:Mice, Inbred BALB C; D008855:Microscopy, Electron, Scanning; D013203:Staphylococcal Infections / Q000378:metabolism / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000378:metabolism / Q000517:prevention & control*; D013536:Suture Techniques; D013537:Sutures; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D007375:Interleukin-1; D014409:Tumor Necrosis Factor-alpha
keywords: infection; periprosthetic joint infection; revision total knee arthroplasty; surgical site infection; suture; total knee arthroplasty