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Li Y, Meng Q, Chen S, Ling P, Kuss MA, Duan B, Wu S. Advances, challenges, and prospects for surgical suture materials. Acta Biomater 2023; 168:78-112. [PMID: 37516417 DOI: 10.1016/j.actbio.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
As one of the long-established and necessary medical devices, surgical sutures play an essentially important role in the closing and healing of damaged tissues and organs postoperatively. The recent advances in multiple disciplines, like materials science, engineering technology, and biomedicine, have facilitated the generation of various innovative surgical sutures with humanization and multi-functionalization. For instance, the application of numerous absorbable materials is assuredly a marvelous progression in terms of surgical sutures. Moreover, some fantastic results from recent laboratory research cannot be ignored either, ranging from the fiber generation to the suture structure, as well as the suture modification, functionalization, and even intellectualization. In this review, the suture materials, including natural or synthetic polymers, absorbable or non-absorbable polymers, and metal materials, were first introduced, and then their advantages and disadvantages were summarized. Then we introduced and discussed various fiber fabrication strategies for the production of surgical sutures. Noticeably, advanced nanofiber generation strategies were highlighted. This review further summarized a wide and diverse variety of suture structures and further discussed their different features. After that, we covered the advanced design and development of surgical sutures with multiple functionalizations, which mainly included surface coating technologies and direct drug-loading technologies. Meanwhile, the review highlighted some smart and intelligent sutures that can monitor the wound status in a real-time manner and provide on-demand therapies accordingly. Furthermore, some representative commercial sutures were also introduced and summarized. At the end of this review, we discussed the challenges and future prospects in the field of surgical sutures in depth. This review aims to provide a meaningful reference and guidance for the future design and fabrication of innovative surgical sutures. STATEMENT OF SIGNIFICANCE: This review article introduces the recent advances of surgical sutures, including material selection, fiber morphology, suture structure and construction, as well as suture modification, functionalization, and even intellectualization. Importantly, some innovative strategies for the construction of multifunctional sutures with predetermined biological properties are highlighted. Moreover, some important commercial suture products are systematically summarized and compared. This review also discusses the challenges and future prospects of advanced sutures in a deep manner. In all, this review is expected to arouse great interest from a broad group of readers in the fields of multifunctional biomaterials and regenerative medicine.
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Affiliation(s)
- Yiran Li
- College of Textiles & Clothing, Qingdao University, Qingdao, 266071, China
| | - Qi Meng
- College of Textiles & Clothing, Qingdao University, Qingdao, 266071, China
| | - Shaojuan Chen
- College of Textiles & Clothing, Qingdao University, Qingdao, 266071, China
| | - Peixue Ling
- Shandong Academy of Pharmaceutical Science, Jinan, 250101, China
| | - Mitchell A Kuss
- Mary & Dick Holland Regenerative Medicine Program and Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program and Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Shaohua Wu
- College of Textiles & Clothing, Qingdao University, Qingdao, 266071, China; Shandong Academy of Pharmaceutical Science, Jinan, 250101, China.
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Zinc-nutrient element based alloys for absorbable wound closure devices fabrication: Current status, challenges, and future prospects. Biomaterials 2021; 280:121301. [PMID: 34922270 DOI: 10.1016/j.biomaterials.2021.121301] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 01/22/2023]
Abstract
The need for the development of load-bearing, absorbable wound closure devices is driving the research for novel materials that possess both good biodegradability and superior mechanical characteristics. Biodegradable metals (BMs), namely: magnesium (Mg), zinc (Zn) and iron (Fe), which are currently being investigated for absorbable vascular stent and orthopaedic implant applications, are slowly gaining research interest for the fabrication of wound closure devices. The current review presents an overview of the traditional and novel BM-based intracutaneous and transcutaneous wound closure devices, and identifies Zn as a promising substitute for the traditional materials used in the fabrication of absorbable load-bearing sutures, internal staples, and subcuticular staples. In order to further strengthen Zn to be used in highly stressed situations, nutrient elements (NEs), including calcium (Ca), Mg, Fe, and copper (Cu), are identified as promising alloying elements for the strengthening of Zn-based wound closure device material that simultaneously provide potential therapeutic benefit to the wound healing process during implant biodegradation process. The influence of NEs on the fundamental characteristics of biodegradable Zn are reviewed and critically assessed with regard to the mechanical properties and biodegradability requirements of different wound closure devices. The opportunities and challenges in the development of Zn-based wound closure device materials are presented to inspire future research on this rapidly growing field.
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Karigyo CJT, Pesarini A. A Simple Modification of the Conventional Figure-of-Eight Sternal Closure Technique. Braz J Cardiovasc Surg 2019; 34:406-411. [PMID: 31454194 PMCID: PMC6713371 DOI: 10.21470/1678-9741-2018-0244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective To describe a new technique of sternal closure, modified from the
conventional figure-of-eight approach, which can provide a secure closure
and prevent sternal complications. Methods The modified technique is based on the intercalation of the caudal portion of
each steel wire passed along the sternum. This is a retrospective analysis
of patients operated with this modified technique at our institution between
January 2014 and December 2016. Results One hundred and forty-three patients underwent sternal closure with the
modified technique. In-hospital mortality rate was 1.4% (n=2). No sternal
instability was observed at 30 days postoperatively. Two patients developed
mediastinitis that required extraction of the wires. Conclusion Short-term results have shown that the modified sternal closure technique can
be used safely and effectively, with complications rates being consistent
with worldwide experience.
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Affiliation(s)
- Carlos Junior Toshiyuki Karigyo
- Hospital Norte Paranaense (HONPAR) Arapongas PR Brazil Hospital Norte Paranaense (HONPAR), Arapongas, PR, Brazil.,Hospital do Câncer de Cascavel (UOPECCAN) Filial Umuarama PR Brazil Hospital do Câncer de Cascavel (UOPECCAN), Filial Umuarama, PR, Brazil
| | - Aldo Pesarini
- Instituto Nossa Senhora Aparecida (INSA) Umuarama PR Brazil Instituto Nossa Senhora Aparecida (INSA), Umuarama, PR, Brazil.,Universidade Paranaense (UNIPAR) Umuarama PR Brazil Universidade Paranaense (UNIPAR), Umuarama, PR, Brazil
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Retrospective analysis of the impact of sternum closure technique on postoperative comfort and rehabilitation. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 15:233-237. [PMID: 30647746 PMCID: PMC6329884 DOI: 10.5114/kitp.2018.80919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/07/2018] [Indexed: 11/17/2022]
Abstract
Introduction Sternum closure techniques have been compared regarding biomechanics, efficacy in high-risk patients and prevention of mediastinitis or sternal dehiscence. There are no papers concerning patients' comfort and postoperative rehabilitation rate. Aim To establish the best surgical closure technique after midline sternotomy regarding the lowest pain level in the postoperative period and the highest rate of postoperative rehabilitation. Material and methods A retrospective analysis was performed on a group of 100 patients after cardiothoracic procedures which was divided into 3 subgroups according to sternal closure technique based on postoperative thoracic X-ray. To assess patients' pain and their physical activity we used a custom questionnaire. The statistical analysis was performed on the data regarding occurrence of wound healing complications risk factors, Numerical Rating Scale (NRS) for Pain score, the number of days until achieving important rehabilitations stages and the occurrence of sternal refixation. Results Subgroups had 35, 33 and 32 patients. The statistical analysis showed significantly lower NRS scores between the 14th (p = 0.0012) (1.17) and 30th (p = 0.0196) day (0.65) after the procedure in the group sutured with only single interrupted wire. There was also a significant difference in the number of days between the operation and the first time the patient could lie sideways (p = 0.0105). There was no statistically significant difference between the three groups regarding other measured factors. Conclusions The single wire suture provides less pain at the 14th and 30th day postoperatively measured on the NRS and ensures faster rehabilitation compared to sternal closing technique which involves placing both single and figure-of-8 sutures.
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Seitz JM, Durisin M, Goldman J, Drelich JW. Recent advances in biodegradable metals for medical sutures: a critical review. Adv Healthc Mater 2015; 4:1915-36. [PMID: 26172399 DOI: 10.1002/adhm.201500189] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/06/2015] [Indexed: 12/13/2022]
Abstract
Sutures that biodegrade and dissolve over a period of several weeks are in great demand to stitch wounds and surgical incisions. These new materials are receiving increased acceptance across surgical procedures whenever permanent sutures and long-term care are not needed. Unfortunately, both inflammatory responses and adverse local tissue reactions in the close-to-stitching environment are often reported for biodegradable polymeric sutures currently used by the medical community. While bioabsorbable metals are predominantly investigated and tested for vascular stent or osteosynthesis applications, they also appear to possess adequate bio-compatibility, mechanical properties, and corrosion stability to replace biodegradable polymeric sutures. In this Review, biodegradable alloys made of iron, magnesium, and zinc are critically evaluated as potential materials for the manufacturing of soft and hard tissue sutures. In the case of soft tissue closing and stitching, these metals have to compete against currently available degradable polymers. In the case of hard tissue closing and stitching, biodegradable sternal wires could replace the permanent sutures made of stainless steel or titanium alloys. This Review discusses the specific materials and degradation properties required by all suture materials, summarizes current suture testing protocols and provides a well-grounded direction for the potential future development of biodegradable metal based sutures.
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Affiliation(s)
- Jan-Marten Seitz
- Department of Biomedical Engineering; Michigan Technological University; 1400 Townsend Dr. Houghton MI 49931 USA
- Department of Materials Science and Engineering; Michigan Technological University; 1400 Townsend Dr. Houghton MI 49931 USA
| | - Martin Durisin
- Department of Otorhinolaryngology; Hannover Medical School; Carl-Neuberg-Str. 1 30625 Hannover Germany
| | - Jeremy Goldman
- Department of Biomedical Engineering; Michigan Technological University; 1400 Townsend Dr. Houghton MI 49931 USA
| | - Jaroslaw W. Drelich
- Department of Materials Science and Engineering; Michigan Technological University; 1400 Townsend Dr. Houghton MI 49931 USA
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Casha AR, Manché A, Gatt R, Duca E, Gauci M, Schembri-Wismayer P, Camilleri-Podesta MT, Grima JN. Mechanism of sternotomy dehiscence. Interact Cardiovasc Thorac Surg 2014; 19:617-21. [PMID: 24966176 DOI: 10.1093/icvts/ivu184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Biomechanical modelling of the forces acting on a median sternotomy can explain the mechanism of sternotomy dehiscence, leading to improved closure techniques. METHODS Chest wall forces on 40 kPa coughing were measured using a novel finite element analysis (FEA) ellipsoid chest model, based on average measurements of eight adult male thoracic computerized tomography (CT) scans, with Pearson's correlation coefficient used to assess the anatomical accuracy. Another FEA model was constructed representing the barrel chest of chronic obstructive pulmonary disease (COPD) patients. Six, seven and eight trans-sternal and figure-of-eight closures were tested against both FEA models. RESULTS Comparison between chest wall measurements from CT data and the normal ellipsoid FEA model showed an accurate fit (P < 0.001, correlation coefficients: coronal r = 0.998, sagittal r = 0.991). Coughing caused rotational moments of 92 Nm, pivoting at the suprasternal notch for the normal FEA model, rising to 118 Nm in the COPD model (t-test, P < 0.001). The threshold for dehiscence was 84 Nm with a six-sternal-wire closure, 107 Nm with seven wires, 127 Nm with eight wires and 71 Nm for three figure-of-eights. CONCLUSIONS The normal rib cage closely fits the ellipsoid FEA model. Lateral chest wall forces were significantly higher in the barrel-shaped chest. Rotational moments generated by forces acting on a six-sternal-wire closure at the suprasternal notch were sufficient to cause lateral distraction pivoting at the top of the manubrium. The six-sternal-wire closure may be successfully enhanced by the addition of one or two extra wires at the lower end of the sternotomy, depending on chest wall shape.
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Affiliation(s)
- Aaron R Casha
- Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta Department of Anatomy, University of Malta, Msida, Malta
| | - Alexander Manché
- Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta
| | - Ruben Gatt
- Metamaterials Unit, Faculty of Science, University of Malta, Msida, Malta
| | - Edward Duca
- Metamaterials Unit, Faculty of Science, University of Malta, Msida, Malta
| | - Marilyn Gauci
- Department of Anaesthesia, Mater Dei Hospital, Msida, Malta
| | | | | | - Joseph N Grima
- Metamaterials Unit, Faculty of Science, University of Malta, Msida, Malta
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Hajj-Chahine J, Jayle C, Menu P, Corbi P. eComment. Multiple approaches for sternal dehiscence. Interact Cardiovasc Thorac Surg 2013; 16:723-4. [PMID: 23674724 DOI: 10.1093/icvts/ivt139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardio-Thoracic Surgery, University Hospital of Poitiers, Poitiers, France
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Durukan AB, Gurbuz HA, Tavlasoglu M, Yorgancioglu C. eComment. Is the sternal closure technique using titanium hooks and wires cost-effective? Interact Cardiovasc Thorac Surg 2013; 16:723. [PMID: 23674723 DOI: 10.1093/icvts/ivt138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ahmet Baris Durukan
- Department of Cardiovascular Surgery, Medicana International Ankara Hospital, Ankara, Turkey
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