Blumenthal Allison M, Bou-Akl Therese, Rossi Mario D, Wu Bin, Ren Wei-Ping, Markel David C
Ascension Providence Health System, Southfield, Michigan, USA.
Wayne State University, Detroit, Michigan, USA.
Orthop J Sports Med. 2020 Dec 15;8(12):2325967120964480. doi: 10.1177/2325967120964480. eCollection 2020 Dec.
For high-tensile strength sutures, past research has largely focused on mechanical properties or bacterial adherence across various manufacturers.
This study investigated high-tensile strength sutures with different shapes but otherwise identical composition. The purpose was to evaluate the differences between high-tensile strength suture wire and suture tape relative to bacterial adherence and bacterial retention after washout.
Controlled laboratory study.
Sutures were implanted in dorsal air pouches of 72 BALB/cJ mice. Experimental pouches were inoculated with ; no bacteria were used in the control conditions. The mice were randomized into 3 groups: group 1 underwent suture extraction 7 days after implantation; group 2 underwent an irrigation procedure, followed by immediate suture extraction on day 7; and group 3 underwent an irrigation procedure on day 7, with delayed suture extraction on day 14 after implantation. The sutures were evaluated using confocal microscopy; electron microscopy; and spectrophotometry, through which optical density, as measured by the amount of scattered light, is directly correlated with the number of bacteria. Histological assessment was performed on the pouches.
Optical density (mean ± SD) was significantly higher for FiberTape sutures than for FiberWire sutures, respectively, at the 2-hour time point for all groups (group 1, 0.0550 ± 0.0081 vs 0.0162 ± 0.006 [ = .0054]; group 2, 0.0225 ± 0.0049 vs 0.0056 ± 0.0006 [ = .0045]; group 3, 0.055 ± 0.0222 vs 0.0043 ± 0.0005 [ = .0103]). Additionally, groups 2 and 3 showed statistically significant results at the 4-hour time points (group 2, 0.0384 ± 0.0087 vs 0.0145 ± 0.0042 [ = .0280]; group 3, 0.0532 ± 0.0159 vs 0.0101 ± 0.0025 [ = .0058]). The wash fluid also demonstrated significantly greater optical density for the FiberTape than the FiberWire sutures, respectively, at the 2-hour time point for all groups (group 1, 0.1657 ± 0.0319 vs 0.0317 ± 0.008 [ = .0063]; group 2, 0.0522 ± 0.0156 vs 0.0127 ± 0.0022 [ = .0219]; group 3, 0.1707 ± 0.0205 vs 0.0191 ± 0.0053 [ < .0001]). No bacterial growth occurred in the control conditions. Histological assessment revealed only mild inflammation in the control groups as compared with more severe responses in the experimental groups at all time points.
FiberTape was associated with increased bacterial adhesion as well as retention as compared with FiberWire in an in vivo murine wound model.
This study demonstrates that suture design influences the occurrence of and ability to clear surgical infection and must be considered when selecting high-tensile strength sutures in a clinical setting.
对于高强度缝线，过去的研究主要集中在不同制造商产品的机械性能或细菌黏附情况。
本研究调查了形状不同但成分相同的高强度缝线。目的是评估高强度缝线钢丝和缝线带在细菌黏附和冲洗后细菌残留方面的差异。
对照实验室研究。
将缝线植入72只BALB/cJ小鼠的背部气袋中。对实验气袋接种 ；对照条件下不使用细菌。将小鼠随机分为3组：第1组在植入后7天进行缝线取出；第2组在第7天进行冲洗，然后立即取出缝线；第3组在第7天进行冲洗，在植入后第14天延迟取出缝线。使用共聚焦显微镜、电子显微镜和分光光度法对缝线进行评估，通过分光光度法，由散射光量测量的光密度与细菌数量直接相关。对气袋进行组织学评估。
在所有组的2小时时间点，FiberTape缝线的光密度（平均值±标准差）显著高于FiberWire缝线（第1组，0.0550±0.0081对0.0162±0.006[ = 0.0054]；第2组，0.0225±0.0049对0.0056±0.0006[ = 0.0045]；第3组，0.055±0.0222对0.0043±0.0005[ = 0.0103]）。此外，第2组和第3组在4小时时间点显示出统计学显著结果（第2组，0.0384±0.0087对0.0145±0.0042[ = 0.0280]；第3组，0.0532±0.0159对0.0101±0.0025[ = 0.0058]）。在所有组的2小时时间点，冲洗液中FiberTape的光密度也显著高于FiberWire缝线（第1组，0.1657±0.0319对0.0317±0.008[ = 0.0063]；第2组，0.0522±0.0156对0.0127±0.0022[ = 0.0219]；第3组，0.1707±0.0205对0.0191±0.0053[ < 0.0001]）。对照条件下未发生细菌生长。组织学评估显示，与所有时间点实验组更严重的反应相比，对照组仅存在轻度炎症。
在体内小鼠伤口模型中，与FiberWire相比，FiberTape与细菌黏附和残留增加有关。
本研究表明缝线设计会影响手术感染的发生和清除能力，在临床环境中选择高强度缝线时必须予以考虑。
