Lambertz Andreas, Schröder Kai Michael, Schöb Dominik Stefan, Binnebösel Marcel, Anurov Michael, Klinge Uwe, Neumann Ulf Peter, Klink Christian Daniel
Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany.
Eur Surg Res. 2015;55(1-2):1-11. doi: 10.1159/000371797. Epub 2015 Feb 25.
Biocompatibility and tissue integration of a surgical suture are decisive factors for wound healing and therefore for the success of sutures. The optimal suture material is still under discussion. Polyvinylidene fluoride (PVDF) is described to have superior properties of biocompatibility and is therefore frequently used as a mesh component. Only little information is available about its use as a suture material. The aim of this study was to evaluate the biocompatibility of PVDF as a suture material in comparison to 5 different established sutures in a rat model.
In 30 male rats, a monofilamental PVDF suture (Resopren®) and 5 established control suture materials [polyester (Miralene®), polytetrafluoroethylene (Gore®), poliglecaprone (Monocryl®), polydioxanone (Monoplus®), polyglactin 910 (Vicryl®), USP size 3-0] were placed in the subcutaneous layer of the abdominal wall without knot or tension. After 3, 7 or 21 days, the abdominal walls were explanted for histopathological and immunohistochemical investigation with special regard to the size and quality of foreign body granuloma and the length of the comet tail-like infiltrate (CTI).
The PVDF sutures showed the smallest size of foreign body granuloma (60 ± 14 µm) and the smallest CTI length (343 ± 60 µm) of all polymers after 21 days. Only PVDF (Resopren) and polydioxanone (Monoplus) showed a significant collagen I/III ratio increase between days 3 and 21 (p = 0.009 and p = 0.016). The quality of foreign body reaction regarding inflammation, proliferation and fibrotic remodeling was similar between all suture materials.
Our data indicate that monofilamental PVDF sutures show a favorable foreign body reaction with small granuloma sizes and CTI length in comparison to established sutures. Its use as a suture material in general surgery could therefore be extended in the future. To reinforce these findings, further clinical studies need to be conducted.
手术缝线的生物相容性和组织整合性是伤口愈合的决定性因素，因此也是缝线成功的关键。最佳缝线材料仍在讨论中。聚偏二氟乙烯（PVDF）被描述为具有卓越的生物相容性，因此经常用作网状组件。关于其作为缝线材料的使用信息很少。本研究的目的是在大鼠模型中，将PVDF作为缝线材料的生物相容性与5种不同的常用缝线进行比较评估。
在30只雄性大鼠的腹壁皮下层放置单丝PVDF缝线（Resopren®）和5种常用对照缝线材料[聚酯（Miralene®）、聚四氟乙烯（Gore®）、聚乙醇酸（Monocryl®）、聚二氧六环酮（Monoplus®）、聚乙交酯910（Vicryl®），USP 3-0号]，不打结且无张力。3、7或21天后，取出腹壁进行组织病理学和免疫组织化学研究，特别关注异物肉芽肿的大小和质量以及彗星尾样浸润（CTI）的长度。
21天后，PVDF缝线在所有聚合物中显示出最小的异物肉芽肿大小（60±14 µm）和最短的CTI长度（343±60 µm）。只有PVDF（Resopren）和聚二氧六环酮（Monoplus）在第3天和第21天之间显示出I/III型胶原比例显著增加（p = 0.009和p = 0.016）。所有缝线材料在炎症、增殖和纤维化重塑方面的异物反应质量相似。
我们的数据表明，与常用缝线相比，单丝PVDF缝线显示出良好的异物反应，肉芽肿大小和CTI长度较小。因此，其在普通外科作为缝线材料的应用未来可能会扩大。为了强化这些发现，需要进行进一步的临床研究。
