Which Is the Optimal Suture for Use in the Abdomen?

A new study suggests that Polyglactin 910 (Vicryl) may be the optimal type of suture to use in the peritoneal cavity.

Researchers at Tokai University School of Medicine (Tokyo, Japan) conducted a study to explore the optimal suture materials for use in the peritoneal cavity, based on the formation of adhesions and abscesses under clean and contaminated conditions. To do so, the researchers incised the parietal peritoneum and muscle layer of rats. The incision was followed by interrupted suturing in the clean group. A suspension of E. coli was sprayed onto the incision in the contaminated group, followed by interrupted suturing. Four types of sutures were used; nonabsorbable multifilament silk, absorbable multifilament Vicryl, absorbable monofilament Polydioxanone (PDS), and Poliglecaprone 25 (Monocryl).

The rats were sacrificed at 2, 4, or 8 weeks after the surgery. The researchers then examined the incidence of adhesions, and found it was low in the clean group with Polyglactin 910. The incidence of adhesions was 96 % or higher regardless of the suture type in the contaminated group. The incidence of severe adhesions was low with Polyglactin 910 and Poliglecaprone 25 and significantly higher with Polydioxanone in the contaminated group. The incidence of abscess formation around the silk was significantly higher than the other three types of sutures in the contaminated group. The study was published in the July 14, 2012, issue of Surgery Today.

“Polyglactin 910 was less likely to form adhesions than the other three types of sutures under both conditions, suggesting that Polyglactin 910 may be the optimal type of suture to use in the peritoneal cavity,” concluded lead author Kenji Ishikawa, PhD, and colleagues. “The reduction of the tensile strength with time did not differ significantly between sutures exposed to contaminated and clean conditions, even for the absorbable sutures.”

Vicryl is an absorbable, synthetic, braided suture, manufactured by Ethicon (Atlanta, GA, USA), a subsidiary of Johnson and Johnson (New Brunswick, NJ, USA). It is indicated for soft tissue approximation and ligation. The suture has a smooth, low friction proprietary coating that reduces tissue drag, and holds its tensile strength for approximately three to four weeks in tissue, completely absorbed by hydrolysis within 60 days.

Vicryl and other polyglycolic acid sutures may be treated to undergo more rapid breakdown in rapidly healing tissues such as mucous membrane, or impregnated with triclosan to provide antimicrobial protection of the suture line. Although the name Vicryl is a trademark of Ethicon, the term vicryl has been used generically referring to any synthetic absorbable suture made primarily of polyglycolic acid.

Related Links:
Tokai University School of Medicine
Ethicon
Johnson and Johnson