Free autologous nerve grafting--comparison of suture materials

The effect of commonly used sutures on inflammation inducing pathogens - an in vitro study

INTRODUCTION

Sutures are a vital part of nearly every surgical procedure designed to close and stabilize wound margins consequently allowing undisturbed wound healing.

AIM

The aim of this study was to evaluate in vitro antimicrobial effect of 4 commonly used sutures.

MATERIALS AND METHODS

The Direct Contact Test was used to evaluate the antibacterial properties of 4 types of sutures: 2 absorbable and 2 non-absorbable braided sutures, immediately or after aging for 2 or 7 days. The tested bacteria were: Staphylococcus epidermidis, Staphylococcus aureus and Pseudomonas aeruginosa. Three-way ANOVA, two-way ANOVA, one-way ANOVA and Tukey multiple comparison were used for statistical analysis.

RESULTS

The absorbable Vicryl Plus exhibited a bactericidal effect against the Staphylococcus strains, which was unaffected by aging. With P. aeruginosa, there was only an initial delay in bacterial growth. All other tested sutures did not have antibacterial effects against any of the tested bacteria (p < 0.001).

CONCLUSIONS

Vicryl Plus had sustained bactericidal effect against the Staphylococcus strains but not against P. aeruginosa. None of the other sutures presented any antibacterial properties.

Nerve regeneration: basic and applied aspects

Increased knowledge is shedding new light on our understanding of central and peripheral nerve anatomy and molecular biology and function. New tools and methods provide important methods for the study of the behavior of cells, axons, and receptors. This review discusses the current state of that knowledge, with particular regard to the efficacy of the Seddon classification of nerve injury. The correlation of that new information to damage and repair of the peripheral sensory nerve, especially the inferior alveolar and lingual nerves, serves to highlight the progress and problems that exist.

Conduction velocity of the human inferior alveolar nerve: a preliminary report

This preliminary report describes a technique to consistently record electrophysiological signals from the uninjured inferior alveolar nerves of human subjects. Bilateral recordings were obtained from 15 consecutive human volunteers. The mean conduction velocity was 67.6 m/s, with no differences shown for right or left sides or gender. Conduction velocity testing could offer a new objectivity in the clinical study of the inferior alveolar nerve, aiding in the documentation, diagnosis, management, and follow-up of the sometimes complex neural lesions that oral and maxillofacial surgeons routinely see.

Electrophysiological assessment of human inferior alveolar nerve function

This study describes a technique for making electrophysiological recordings from the inferior alveolar nerve of conscious human subjects. Recordings were obtained from 6 of 10 subjects, with consistent waveform latencies and amplitudes across subjects. The neurogenic origin of the responses was verified by blocking the nerve with 2% xylocaine, resulting in a loss of the waveform. The method is relatively simple, tolerated well by patients, and yields consistent electrophysiological information. Proposed refinements of the technique could result in a clinically useful method of objectively assessing the functional state of the inferior alveolar nerve following injury or surgical intervention.

Comparison of nerve regeneration through different types of neural prostheses

Rat sciatic nerve regeneration through three synthetic neural prostheses was compared with regeneration through nerve allografts. The synthetic prostheses were either nonpermeable nonabsorbable (Silastic), permeable absorbable (polyglactin mesh), or permeable nonabsorbable (polypropylene mesh). Animals were evaluated at 10, 24, and 90 days. Functional analysis of nerve regeneration was performed by noninvasive methods: electromyography and walking tracks. Nerve tissue was examined with routine histologic and immunofluorescent techniques. A compressive neuropathy developed with the use of the Silastic implant. A neutrophilic inflammatory infiltrate was consistently associated with implantation of the polyglactin mesh. A strong connective tissue response was noted around the polypropylene mesh. Early recovery of nerve function was seen with the Silastic implants, however, overall nerve function was best in the nerve allograft and polypropylene mesh groups. Polyglactin implantation increases the local inflammatory response and should not be used for nerve anastomoses. If Silastic entubulation is used, it should be removed between 24 and 90 days.

Electrodiagnostic evaluation of the uninjured rabbit inferior alveolar nerve

This investigation describes the electrophysiology of the uninjured rabbit inferior alveolar nerve. There were no differences in the measured waveform parameters between animals nor between the two sides of each animal. The model is reliable and could be applied to basic studies of inferior alveolar nerve regeneration and the effects of pharmacologic or surgical intervention.