Prolonged joint cavity retention of tranexamic acid achieved by a solid-in-oil-in-gel system: A preliminary study.

Tranexamic acid (TXA) is an anti-fibrinolysis agent widely used in postoperative blood loss management. As a highly water-soluble drug, TXA is suffering from rapid clearance from the action site, therefore, large amount of drug is required when administered either by intravenously or topically. In this study, a TXA preparation with prolonged action site residence was designed using the nano-micro strategy. TXA nanoparticles were dispersed in oil by emulsification followed by lyophilization to give a solid-in-oil suspension, which was used as the oil phase for the preparation of TXA-loaded solid-in-oil-in-water (TXA@S/O/W) system. The particle size of TXA in oil was 207.4 ± 13.50 nm, and the particle size of TXA@S/O/W was 40.5 µm. The emulsion-in-gel system (TXA@S/O/G) was prepared by dispersing TXA@S/O/W in water solution of PLGA-b-PEG-b-PLGA (PPP). And its gelling temperature was determined to be 26.6 ℃ by a rheometer. Sustained drug release was achieved by TXA@S/O/G with 72.85 ± 7.52 % of TXA released at 120 h. Formulation retention at the joint cavity was studied by live imaging, and the fluorescent signals dropped gradually during one week. Drug escape from the injection site via drainage and absorption was investigated by a self-made device and plasma TXA concentration determination, respectively. TXA@S/O/G showed the least drug drainage during test, while more than 70 % of drug was drained in TXA@S/O/W group and TXA solution group. Besides, low yet steady plasma TXA concentration (less than 400 ng/mL) was found after injecting TXA@S/O/G into rat knees at a dosage of 2.5 mg/kg, which was much lower than those of TXA dissolved in PPP gel or TXA solution. In conclusion, sustained drug release as well as prolonged action site retention were simultaneously achieved by the designed TXA@S/O/G system. More importantly, due to the steady plasma concentration, this strategy could be further applied to other highly water-soluble drugs with needs on sustained plasma exposure.

Outcomes of posterior sheath supplementation with Vicryl mesh in TAR-a single-center study.

INTRODUCTION: In the Transversus Abdominis Release (TAR) procedure, ideally, the posterior sheath is completely reapproximated to establish an interface isolating the polypropylene mesh from visceral contents. When primary closure of the posterior sheath is unachievable, Vicryl mesh is commonly used to supplement the posterior sheath closure and an uncoated polypropylene mesh is placed superficial to the Vicryl mesh. The long-term implications of utilizing Vicryl mesh as an antiadhesive barrier are poorly understood. In this study, we aimed to assess our outcomes when utilizing Vicryl mesh to supplement the posterior sheath defects when placed underneath polypropylene mesh in patients undergoing posterior component separation. METHODS: Adult patients who underwent VHR with concurrent TAR procedure with a permanent synthetic mesh and posterior sheath supplementation with Vicryl mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and December 2022 were queried retrospectively from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, long-term mesh-related complications, and pragmatic hernia recurrence. RESULTS: 53 patients who underwent TAR procedure with posterior sheath supplementation using Vicryl mesh and had a minimum 12-month follow-up were identified. Of the 53 patients, 94.3% presented with recurrent hernias, 73.6% had a midline hernia, 7.5% had a flank hernia, and 18.9% had concurrent parastomal hernia. The mean hernia width was 24.9 cm (± 8.8 cm). No Vicryl mesh-related operative complications were identified in our study, with no instances of mesh erosion, fistulas, or interventions for small bowel obstruction. Skin necrosis requiring reoperations was observed in three patients (5.7%), leading to permanent mesh excision in two cases (3.8%) without intraabdominal visceral involvement. Throughout the 12-month follow-up, 23 incidences (43.4%) of surgical site occurrences (SSOs) and surgical site occurrences requiring procedural intervention (SSOPI) were documented. CONCLUSIONS: Our findings suggest that posterior sheath supplementation with Vicryl mesh is a feasible approach to achieve posterior sheath closure in challenging abdominal wall reconstruction cases. Given the absence of notable mesh-related complications and a similar hernia recurrence rate to cases without posterior sheath supplementation, Vicryl mesh can be used to safely achieve posterior sheath closure in complex reconstructions with insufficient native tissue.

Comparison of the Efficacies of Vicryl Rapide and Prolene Sutures in Transcolumellar Incision.

<b><br>Introduction:</b> Septorhinoplasty aims to enhance nasal function and appearance. This common but complex procedure has demonstrated advancements with both open and endonasal approaches. The selection of sutures can impact patient comfort and scar outcomes, presenting both advantages and disadvantages.</br> <b><br>Aim:</b> This study was conducted to compare the cosmetic outcomes of the use of absorbable polyglactin 910 (PG) (Vicryl Rapide 5/0; Ethicon Inc.) and nonabsorbable polypropylene (PP) (Prolene 5/0; Ethicon Inc.) in open septorhinoplasty in terms of surgical scarring.</br> <b><br>Methods:</b> The sample of this prospective, randomized, single-blind study consisted of 42 patients who underwent open septorhinoplasty. The patients were randomized into the vicryl rapide (n = 16) and prolene (n = 26) suture groups. The groups were comparatively evaluated by two surgeons in terms of surgical scarring, pigmentation, level difference, indentation, and general appearance based on patient photographs taken in the 2nd week, 6th weeks and 12th week post-op.</br> <b><br>Results:</b> The mean age of the vicryl rapide and prolene groups was 26.9 5.7 years and 24.6 3.9 years, respectively. There was no significant difference between the groups in any of the parameters investigated within the scope of the study in postoperative week 2, 6, and 12 (P > 0.05). On the other hand, intragroup analyses revealed that suture scar significantly decreased in the vicryl rapide group in the 6th and 12th weeks compared to the 2nd week (P < 0.05), while no significant difference was observed in the prolene group in the suture scars in week 6 and 12 compared to week 2 (P > 0.05).</br> <b><br>Conclusions:</b> Inverted V trans-columellar incisions sutured with rapidly absorbable suture material resulted in significantly less suture discomfort and did not significantly increase the risk of postoperative infection compared to nonabsorbable suture material. However, there was no significant difference between the two suture materials in terms of scar appearance.</br>.

Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy.

Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.

A Novel Method to Fix Paediatric Mandibular Fracture using 2-0 Polyglactin Suture: A Technical Note.

BACKGROUND: Reduction and stabilisation of fractures at the earliest is valuable in the paediatric age groups. This novel technique focuses on stabilisation of the fracture fragments using vicryl, which has an added advantage to conventional plating and wiring. This study aimed on a novel cost-effective technique of stabilising the paediatric mandibular fracture using 2-0 resorbable polyglactin 910 suture with minimal trauma to tooth buds and bone and adequate stability. TECHNIQUE: After raising a full-thickness mucoperiosteal flap, the fracture segments are identified and reduced. 1.6mm drill bit is used to make holes through the buccal cortex on either side of the fractured segment in an anteroposterior direction. The patency of holes is checked by passing a long 26-gauge wire. The proximal end of the wire is bent into a loop, a 2-0 resorbable polyglactin suture (vicryl) is passed through this loop and the loop is pressed in place to lock the suture. The wire with the attached suture is pulled through the distal end. Once the suture is secure in place, the 26G wire is cut, and the two ends of sutures are knotted and stabilised. The mucoperiosteal flap is then closed. CONCLUSION: A novel method of stabilisation of paediatric fracture without hampering the tooth and jaw growth, especially in the financially unstable population. 2-0 polyglactin 910 suture is cost-effective, $2 US, compared to resorbable plates costing about $150 US, and easily available. Polyglactin 910 takes 40-60 days for resorption, and half-life tensile strength is 2 weeks; thus, it gives adequate stability and time for callus formation and does not damage the tooth buds or bone by cutting through them.

Lateral tarsal strip procedure: comparison of absorbable sutures and non-absorbable polypropylene suture. Does the suture type matter?

BACKGROUND/OBJECTIVES: To determine whether the success and complication rates of the Lateral Tarsal Strip (LTS) Procedure, when treating involutional ectropion/entropion, is influenced by the use of suture when attaching the tarsal strip to the periosteum. SUBJECTS/METHODS: Multi-centre retrospective comparative study of re-operation and complication rates (Recurrence, Dehiscence, Suture Infection, Granuloma, Haemorrhage, Residual-Lid Laxity, Suture Extrusion and Repeat Procedure) in LTS, between 01/01/2017 and 01/01/2022 who met the inclusion/exclusion criteria, for involutional ectropion/entropion using an absorbable polyglactin (vicryl) and non-absorbable polypropylene suture (prolene). RESULTS: 1079 operations in 891 patients (36% female, average age 81.4 years) were performed with an average follow-up of 1.785 years. 588 operations in 475 patients were performed using prolene whilst 491 procedures in 416 patients were performed using vicryl sutures. Of these, 61% were performed by a consultant surgeon in the prolene group compared to 49.7% in the vicryl group. Overall complication rates between prolene and vicryl were 24.7% and 29.7% (p = 0.061) respectively. Higher complication rates for post-operative residual lid laxity, granuloma and suture infection were greater in the vicryl group versus prolene (2.65% and 0.51% p = 0.004, 2.24% and 0.68% p = 0.03, 1.83% and 0.17% p = 0.007 respectively). Non-significant results for dehiscence or repeat procedures (2.24% and 2.21% p = 0.974, 6.72% and 9.01% p = 0.166 respectively). CONCLUSIONS: Both sutures are effective for the correction of involutional ectropion/entropion with LTS. Dehiscence and redo rates were not statistically significant. Nevertheless, the use of vicryl suture was found to be associated with a higher complication rate for: post-operative residual lid laxity, granuloma and suture infection.

An Experimental Design to Compare the Compatibility of Absorbable and Nonabsorbable Suture Materials in the Lateral Canthus Area.

Polyglactin 910 (Vicryl) and polypropylene (Prolene) are common suture materials used in ophthalmic surgical procedures. However, there are limited studies assessing tissue reactions to different sutures in eyelid areas. In this study, these suture materials were used subcutaneously in 10 lateral canthi of 5 pigs. Clinical reactive score (CRS) was assessed 14 days and 60 days after surgery. On histology, subcutaneous tissue reactions were assessed by the presence of different inflammatory cells, and the aggregate tissue irritation score was calculated. CRS and the histology score did not differ between these sutures. None of the suture materials used were superior for use in the lateral canthi of pig eyes. Therefore, we recommend both of these sutures for use in the subcutaneous tissue of the eyelid area in animal experiments or clinical practice.

The effect of triclosan-coated sutures on the incidence of surgical site infection in laparoscopic sleeve gastrectomy, laparoscopic appendicectomy or laparoscopic cholecystectomy: A multi-centre, double-blind, randomized, intra-individual study.

Surgical site infection (SSI) is a common cause of post-operative morbidity. According to the latest report announced by CDC, the SSI accounts for 20% of healthcare-associated infection with a high risk of mortality up to twofold to 11-fold increase with high economic burden for the prolonged hospital stay. Port site infection (PSI) is a subgroup of SSI occurring at the ports of laparoscopy. We tried to determine the efficacy of polyglactin 910 suture coated with triclosan in lowering the rate of PSI in some of the clean-contaminated wound surgeries. This study included 480 individuals eligible for laparoscopic cholecystectomy, appendicectomy or sleeve operations. Polyglactin 910 sutures coated with triclosan were used in one port site incision while polyglactin 910 sutures were used in the other port sites incisions. In patients who underwent laparoscopic cholecystectomy and appendicectomy, the incidence of PSI was significantly lower in the triclosan-coated sutures. In sleeve gastrectomy patients, although a lower number of triclosan-coated sutures developed PSI, there was no statistically significant difference between triclosan and non-triclosan-coated sutures. This study showed that using sutures coated with antiseptics like triclosan has clinical benefits to prevent SSIs in most of the laparoscopic surgeries.

Subcuticular Suture Type at Cesarean Delivery and Infection Risk: A Systematic Review and Meta-Analysis.

OBJECTIVES: Surgical site infections (SSI) are common causes of postoperative morbidity at cesarean delivery (CD). The objective of this study was to compare the risk of SSI and other wound complications associated with different suture materials for subcuticular skin closure at CD. DATA SOURCES: We searched Cochrane Library, MEDLINE, Embase, and Clinicaltrials.gov from inception to June 3, 2021, and limited our search to English, peer-reviewed, randomized controlled trials and cohort studies. STUDY SELECTION: Of 1541 titles identified, 4 studies met the selection criteria and were included. Studies were included if the population was pregnant individuals undergoing transverse incision primary or repeat, elective or emergent CD with subcuticular skin closure, and if outcomes related to SSI, wound seroma, hematoma, or dehiscence were reported. We completed the assessment using Covidence review management software. DATA EXTRACTION AND SYNTHESIS: Two authors independently reviewed studies and assessed the risk of bias using the Cochrane 'Risk of bias' tool for randomized trials (RoB 2.0) and the Cochrane Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tools for cohort studies. We compared SSI risk and secondary outcomes of hematoma, seroma, and dehiscence between skin closure with monofilament (poliglecaprone 25 or polypropylene) versus multifilament (polyglactin 910) sutures using a fixed-effects meta-analysis. Statistical heterogeneity was estimated using the I2 statistic. Monofilament sutures were associated with a reduced risk of SSI (RR = 0.71, 95% CI 0.52-0.98, I2 = 0%) compared to multifilament sutures. There was no difference in the risk of secondary outcomes. CONCLUSION: Monofilament suture for subcuticular skin closure at CD was associated with decreased risk of SSI compared to multifilament suture.

Evaluation of the in vitro performance of the double forwarder knot, compared to square and surgeon's knots using large gauge suture.

OBJECTIVE: The aim of the study was to evaluate the strength and size of the double forwarder (DF) knot in 2 and 3 USP polyglactin 910 when used to form a ligature and to compare the knot holding capacity (KHC), size and weight of the DF knot to surgeon's (SU) and square (SQ) knots with varying numbers of throws. STUDY DESIGN: Laboratory study. STUDY POPULATION: Knotted suture. METHODS: Knots were tied using 2 and 3 USP polyglactin 910 and tested on a universal testing machine under linear tension. Mode of failure and (KHC) were recorded. Knot volume and weight were determined by digital micrometer and balance. KHC, size, and weight between knot type, number of throws, and suture type and size were compared using ANOVA testing, with p < .05 as significant. RESULTS: In both suture types, DF knots had a higher KHC than SQ/SU knots (p < .004), with the exception of SU knots with 6-8 throws in 3 USP polyglactin 910 (p > .42). All DF knots failed by suture breakage at the knot, as did all SQ/SU knots with >6 throws. DF knots in 2 and 3 USP polyglactin 910 were larger and heavier than SQ and SU knots when the same number of throws was applied (p < .003). CONCLUSION: Self-locking DF knots provided increased strength compared to SU/SQ in large gauge suture but only when fewer than six throws are applied to SU/SQ knots. CLINICAL RELEVANCE: The new DF knot could be an alternative for a secure ligature.

Conjunctiva in strabismus surgery - to stitch or to stick? - A randomized clinical trial.

PURPOSE: To evaluate the clinical outcomes with fibrin glue in comparison with vicryl sutures for limbal conjunctival wound closure in strabismus surgery. METHODS: In this prospective interventional study, patients undergoing horizontal muscle strabismus surgery were randomized into two groups: the vicryl suture group and the fibrin glue group. The limbal conjunctival incisions were closed with 8-0 vicryl in the suture group and with fibrin glue in the other group. The outcomes measured were post-operative conjunctival inflammation and wound apposition, patient comfort with the help of a questionnaire, and conjunctival thickness using anterior segment optical coherence tomography (AS-OCT) for both groups at 6 weeks. RESULTS: The study included 64 eyes of 64 patients (32 eyes in each group). The fibrin glue group performed better than the vicryl suture group for most of the symptoms like redness, irritation, watering, and foreign body sensation till 2 weeks post-operatively ( P < 0.001), after which both the groups performed similarly. As for clinical signs, no significant difference was noted between the two groups, except for conjunctival hyperemia, which was significantly lesser in the fibrin glue group at 2 weeks post-operatively ( P < 0.001). The conjunctival thickness measured at 6 weeks using AS-OCT revealed that the thickness increased significantly in the suture group compared to that in the glue group ( P < 0.001 medial site, P = 0.004 lateral site). CONCLUSION: Because of greater patient comfort and reduced inflammation associated with fibrin glue, it may be considered as a procedure of choice for conjunctival wound closure in strabismus surgery in the absence of the cost constraints.

Assessing Endoscopic Suture Performance of Gynecology and Obstetrics Residents Following Methodic Training.

OBJECTIVE: To evaluate the performance of residents in gynecology and obstetrics before and after practicing laparoscopic sutures, to establish when the training shows the best results, in addition to comparing whether being in different years of residency influences this progression. METHODS: A prospective cohort study involving 32 medical residents evaluated with a pretest to establish their previous knowledge in laparoscopic suture. This test consisted of knotting two wires, one made of polypropylene and the other of polyglactin, with a blocking sequence of five semi-knots. We set a 30-minute limit to complete the task. Then, the residents held four training meetings, focusing on suture, Gladiator rule, knot, and symmetries, in addition to executing blocking sequences. A second test to establish progress was performed. RESULTS: Regarding the time spent to make the stiches using polyglactin wire, a statistically significant time improvement (p < 0.01) was observed, with a 10.67-minute pretraining median (mean 12.24 minutes) and a 2.53-minute posttraining median (mean 3.25 minutes). Regarding the stitches with polypropylene wire, a statistically significant time improvement (p < 0.05) was also observed, with a 9.38-minute pretraining median (mean 15.43 minutes) and a 3.65-minute posttraining median (mean 4.54 minutes). A total of 64.2% of the residents had been able to make the knot with polypropylene previously. One hundred percent were able to complete the task in the posttest. CONCLUSION: Model training using the Gladiator rule for laparoscopic suture improves the knotting time with statistically similar performance, regardless of the year of residency, after systematic training.

OBJETIVO: Avaliar a performance de residentes em ginecologia e obstetrícia antes e depois de praticarem suturas laparoscópicas, com o intuito de estabelecer quando o treinamento mostra os melhores resultados, comparando se estar em diferentes da residência influencia essa progressão. MéTODOS: Um estudo coorte prospectivo envolvendo 32 médicos residentes avaliados com um teste pré-treinamento para avaliar seus conhecimentos prévios em sutura laparoscópica. Esse teste consistia em atar nós em dois fios, um de polipropileno e o outro de poliglactina, com uma sequencia de bloqueio de cinco seminós. Definiu-se um limite de 30 minutos para se completar a tarefa. Depois, os residentes tiveram quatro reuniões de treinamento, focadas em sutura, técnica da Regra do Gladiador, nós e simetria, executando, ainda, uma sequência de pontos. Um segundo teste foi feito para avaliar o progresso. RESULTADOS: Com relação ao tempo para realizarem os pontos com fio de poliglactina, uma melhora de tempo estatisticamente significativa (p < 0.01) foi observada, com uma mediana de 10.67 minutos no pré-treinamento (média de 12.24 minutos) e uma mediana de 2.53 minutos no pós-treinamento (média de 3.25 minutos). Com relação ao fio de polipropileno, uma melhora de tempo estatisticamente significativa (p < 0.05) também foi observada, com uma mediana de pré-treinamento de 9.38 minutos (média de 15.43 minutos) e uma mediana de pós-treinamento de 3.65 minutos (média de 4.54 minutos). Um total de 64.2% dos residentes foram capazes de realizar os nós com polipropileno inicialmente. Cem por cento do residentes foram capazes de completar a tarefa no pós-teste. CONCLUSãO: O modelo de treino usando a técnica da Regra do Gladiador para sutura laparoscópica melhora o tempo de atar nós com uma performance estatisticamente similar, não havendo diferenças quanto ao ano da residência, após treinamento sistematizado.

Design of experiments approach for the development of a validated method to determine the exenatide content in poly(lactide-co-glycolide) microspheres.

Due to the lack of pharmacopeia guidelines for injectable microspheres based on poly (D, L-lactide-co-glycolide) (PLGA), an internal method validation is a critical prerequisite for quality assurance. One of the essential issues of developing peptide-based drugs loaded PLGA microspheres is the precise determination of the amount of peptide drug entrapped in the microspheres. The aim of this study is the development and optimization of a method for measuring the drug content loading of PLGA microspheres using exenatide as a model peptide drug. Exenatide-loaded PLGA microspheres were prepared by a double emulsion solvent evaporation method. The extraction method to determine exenatide content in microspheres was optimized using Design of Experiments (DoE) approach. After the initial screening of six factors, using Fractional Factorial design (FFD), four of them, including type of organic solvent, buffer/organic solvent ratio (v/v), shaking time and pH, exhibited significant effects on the response, namely the exenatide loading, and a Box-Behnken design (BBD) was subsequently applied to obtain its optimum level. The optimum level for organic solvent volume, buffer/organic solvent ratio, shaking time, and pH were 4 ml, 1, 5.6 hrs, and pH 6, respectively. The exenatide content in microspheres under these conditions was 6.4 ± 0.0 (%w/w), whereas a value of 6.1% was predicted by the derived equation. This excellent agreement between the actual and the predicted value demonstrates that the fitted model can thus be used to determine the exenatide content.

Double-Layered Hand-Sewn versus Stapled Intestinal Anastomosis in Patients Who Underwent Ileal Urinary Diversion in Radical Cystectomy: A Comparative and Cost Effective Study.

INTRODUCTION: Intestinal anastomosis can be performed by hand suturing (single layer or double layer) or by a mechanical suturing machine. The aim of the study was to compare complications, operative time, and costs of the intestinal anastomosis techniques. METHODS: A retrospective comparative study was conducted including patients who underwent radical cystectomy and uretero-ileo-cutaneostomy or vescica ileale Padovana orthotopic neobladder. Double-layered hand-sewn intestinal anastomosis (HS-IA) were performed using Vicryl stitches. Mechanical-stapled intestinal anastomosis (MS-IA) were performed with a mechanical stapler. RESULTS: Data of 195 patients who underwent were collected. 100 (51.3%) patients underwent HS-IA and 95 (48.7%) patients underwent MS-IA. Considering the complications classified according to Clavien-Dindo, a statistical difference with higher incidence for grade one in the HS-IA both in the ileal conduit group and in the neobladder one than the MS-IA (15.8% and 8.7%, respectively, in HS-IA vs. 1.7% and none in MS-IA). There is not a significant difference in time to flatus and time to defecation. Difference is recorded in the ileal conduit groups for the length of stay (10 days, range 9-12 with HS-IA vs. 13 days range 12-16 days with MS-IA (p < 0.001). The cost of the suture thread used for a single operation was 0.40 euros, whereas the overall cost of a disposable mechanical stapler and one refill was 350.00 €. CONCLUSION: Both HS-IA and MS-IA are safe and effective for patients. The cost for the stapling device is 350 €, in contrast, the cost for Vicryl sutures is negligible.

Impact of Intraoperative Factors on the Development of Postpartum Septic Complications.

Background and Objectives: Triclosan-coated sutures (antibacterial sutures) can reduce the risk of postoperative surgical site infection. This study aimed to investigate the effect of intraoperative factors, including antibacterial sutures, on the risk of postpartum septic complications. Materials and Methods: The prospective study included patients who underwent caesarean section. The exclusion criterion was chorioamnionitis. The investigation group patient's (n = 67) uterus and fascial sheath of the abdominal wall were sutured with triclosan-coated polyglactin 910 sutures during surgery. The control group consisted of 98 patients using uncoated polyglactin 910 sutures only. The patients were contacted by phone after the 30th postoperative day. Results: No significant difference was found between the investigation group and the control group in the development of postpartum endometritis (11.7% in the investigation group vs. 8.4% in the control group, p = 0.401), wound infection (6.3% vs. 3.6%, p = 0.444) or patients experienced any septic complication (15.9% vs. 12%, p = 0.506). Postpartum endometritis was more common in patients who underwent instrumental uterine examination during the surgery (23.8% vs. 18%, p = 0.043). A moderately strong correlation was found for haemoglobin level on the third-fourth postoperative day with the development of postpartum septic complications, p < 0.001, Pearson coefficient -0.319. Post-caesarean delivery septic complications were not statistically more common in patients with blood loss greater than 1 L. The incidence of post-caesarean endometritis was 13.4%, and wound infection was 4.8% in this study's hospital, having five to six thousand deliveries per year. Conclusions: Using antibacterial sutures during caesarean section does not affect the incidence of postpartum septic complications. Instrumental uterine examination during caesarean section increases the risk of post-caesarean endometritis and is, therefore, not recommended. Haemoglobin level on the 3rd-4th postoperative day, rather than the estimated blood loss during surgery, affects the development of postpartum septic complications.

Impact of Inner Layer Renorrhaphy Suture on Renal Artery Pseudoaneurysm Formation Following Robotic-assisted Partial Nephrectomy.

OBJECTIVE: To report the impact of resection base inner layer renorrhaphy suture type on renal artery pseudoaneurysm (RAP) rate following robotic-assisted partial nephrectomy (RAPN). METHODS: Five hundred and sixty-three consecutive RAPNs performed by a single surgeon were retrospectively reviewed. Patients were classified into 3 categories: (1) No base suture, (2) monofilament barbed suture (2-0 V-Loc 180 absorbable suture, Medtronic, Minneapolis, MN), (3) polyglactin 910 (2-0 Vicryl coated suture, Ethicon Inc, Cincinnati, OH). In a secondary analysis, we evaluated suturing (Vicryl and V-Loc) vs no base suture. All patients had outer cortical renorrhaphy performed with 0-Vicryl suture utilizing the standard sliding clip technique. RESULTS: One hundred ten patients (19.5%) had V-Loc suturing, 255 patients (45.3%) had Vicryl suturing, and 198 patients (35.2%) had no base suture. Patients had a median age of 62.8years (interquartile range: 53.5-69.7) and median RENAL score was 8 (6-9). Median mass size from preoperative imaging was 3.0 cm (2.5-4.0) for V-Loc, 3.3 cm (2.5-4.2) for Vicryl, and 2.0 cm (1.8-3.0) for no base suture (P < .001). Overall, 21 patients (3.7%) developed a symptomatic postoperative RAP. The rate of RAP was 3.6% (4/110) for V-Loc, 3.9% (10/255) for 2-0 Vicryl, and 3.5% (7/198) for no base suture (P = 1.00). Similarly, the rate of RAP was 3.5% (7/198) for no base suture and 3.8% (14/365) for base suture (P = 1.00). CONCLUSION: Utilization of base suture and type of base suture used during RAPN was not predictive of postoperative RAP development.

The comparison of the suture materials on intestinal anastomotic healing: an experimental study.

BACKGROUND: This experimental comparative study was to evaluate the local effects of three different suture materials on in-testinal anastomosis healing. METHODS: Ethical approval was obtained from the University of Ethical Committee (E-60758568-020-176720). A prospective, experimental comparative analysis was conducted on 24 rats. They were divided into three equal groups; Group 1 underwent colonic anastomosis with Vicryl suture material, Group 2 underwent colonic anastomosis with polypropylene suture; and Group 3 underwent colonic anastomosis with polydioxanone (PDS) suture. The second operation underwent the 7th post-operative day. Adhesion score, anastomotic leakage, anastomotic bursting pressure, hydroxyproline levels, and histopathologic examination were evaluated. RESULTS: All animals survived, and no leakage, intestinal obstruction, or wound infection was observed during the experiment. The adhesion score was evaluated according to the Diamond classification and same in all groups. Median anastomotic bursting pressure was 125.75 mmHg (10-241) in the Vicryl group, 159.25 mmHg (113-190) in the polypropylene group, and 154.50 mmHg (20-212) in the PDS group. Hydroxyproline tissue concentrations were in the Vicryl group 1699.92±220.8 ng/mg (range: 1509.81-2186.47), in the polypropylene group 1126.24±607.12 ng/mg (range: 53.22-1815.63), and 1547.86±335.2 ng/mg (range: 973.66-1973.2) in PDS group. There was no difference among groups regarding the inflammatory response evaluated by histopathology. There was no statistical significance in all variables evaluated. CONCLUSION: This experimental study demonstrates that suture materials did not worsen tissue healing during intestinal anastomosis. Absorbable, slowly-absorbable, and non-absorbable suture materials could be used safely in every situation.

Bioactive Suture with Added Innate Defense Functionality for the Reduction of Bacterial Infection and Inflammation.

Surgical site infections (SSI) are a clinical and economic burden. Suture-associated SSI may develop when bacteria colonize the suture surface and form biofilms that are resistant to antibiotics. Thrombin-derived C-terminal peptide (TCP)-25 is a host defense peptide with a unique dual mode of action that can target both bacteria and the excessive inflammation induced by bacterial products. The peptide demonstrates therapeutic potential in preclinical in vivo wound infection models. In this study, the authors set out to explore whether TCP-25 can provide a new bioactive innate immune feature to hydrophilic polyglactin sutures (Vicryl). Using a combination of biochemical, biophysical, antibacterial, biofilm, and anti-inflammatory assays in vitro, in silico molecular modeling studies, along with experimental infection and inflammation models in mice, a proof-of-concept that TCP-25 can provide Vicryl sutures with a previously undisclosed host defense capacity, that enables targeting of bacteria, biofilms, and the accompanying inflammatory response, is shown.

Efficacy of mesh coverage in surgical bullectomy for primary spontaneous pneumothorax: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Thoracic surgeons are now adopting a new method of using a mesh covering to reduce recurrence in surgical pleurodesis for pneumothorax. We aimed to review the literature and compare the outcomes of using mesh covering as an additional procedure during surgical pleurodesis. METHODS: A comprehensive search was performed from inception to October 2022 on PubMed, Embase, Cochrane and Scopus. Randomised controlled trials (RCTs) and observational cohort studies (OCSs) comparing the use of mesh coverage, and different materials were included. Data were extracted to compare recurrence and other outcomes using a random effect model. RESULTS: 23 studies consisting of 2 RCTs and 21 OCSs totalling 5092 patients were included. Patients with a mesh had a significantly lower recurrence (OR = 0.22, 95% CI 0.12-0.42, p < 0.0001) and a shorter duration of chest tube drainage (SMD = -0.74 days, 95% CI -0.28 to -1.20, p < 0.0001) but no significant difference in the length of operation. The use of polyglycolic acid (PGA) and vicryl mesh was associated with a significantly shorter duration of chest tube drainage [(PGA, SMD = 0.83 days, 95% CI 0.14-1.52, p < 0.0001), (vicryl, SMD = 1.06 days, 95% CI 0.71-2.82, p = 0.0005)]. They also had a shorter post-operative length of stay than oxidized regenerative cellulose (ORC) but this was not statistically significant. CONCLUSION: The use of a mesh material reduced the incidence of post-operative air leaks in the short term and the recurrence rate in the long term. Some mesh materials such as PGA and vicryl performed better than other materials.

Gemcitabine and rapamycin-loaded mixed polymeric thermogel for metastatic pancreatic cancer therapy.

Pancreatic ductal adenocarcinoma (PDAC) is the 4th leading cause of cancer-related death and has a poor 5-year overall survival. The superior therapeutic benefits of combination or co-administration of drugs as intraperitoneal chemotherapy have increased interest in developing strategies to deliver chemotherapeutic agents to patients safely. In this study, we prepared a gel comprising the thermosensitive poly(lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(lactide-co-glycolide) (PLGA-PEG-PLGA) polymer and gemcitabine (GEM), which is currently used as the primary chemotherapy for PDAC and rapamycin (RAPA), a mammalian TOR (mTOR) inhibitor, to deliver the drug through intraperitoneal injection. We performed in vitro cytotoxicity experiments to verify the synergistic effects of the two drugs at different molar ratios and characterized the physicochemical properties of the GEM, RAPA, and GEM/RAPA-loaded thermosensitive PLGA-PEG-PLGA gels, hereafter referred to as (g(G), g(R), and g(GR)), respectively. The g(GR) comprising PLGA-PEG-PLGA polymer (25% w/v) and GEM and RAPA at a molar ratio of 11:1 showed synergism and was optimized. An in vitro cytotoxicity assay was performed by treating Panc-1-luc2 tumor spheroids with g(G), g(R), or g(GR). The g(GR) treatment group showed a 2.75-fold higher inhibition rate than the non-treated (NT) and vehicle-treated groups. Furthermore, in vivo drug release assay in mice by intraperitoneal injection of g(G), g(R), or g(GR) showed a more rapid release rate of GEM than RAPA, similar to the in vitro release pattern. The drugs in the gel were released faster in vivo than in vitro and degraded in 48 h. In addition, g(GR) showed the highest anti-tumor efficacy with no toxicity to mice. These results provide evidence for the safety and efficacy of g(GR) for intraperitoneal drug delivery. This study will assist in developing and clinically administering topical anti-cancer formulations.