Search Results (67)

Purpose: This retrospective observational study evaluates the efficacy and safety of a novel scleral fixation technique of the fluocinolone acetonide (FAc) implant in four consecutive patients with post-surgical macular edema (PSME). Case Presentation: Four patients with PSME underwent intrascleral tunnel clamping (ITC) of the FAc implant due to lens defects. A 25-gauge sclerotomy was made 3.5 mm from the limbus and the implant was inserted into it until its end reached the edge of the sclera. Then, an 8-0 absorbable suture was passed through the sclera without penetrating the implant, thereby clamping the sclera around the FAc. All the patients showed improvements in best-corrected visual acuity (from a mean of 20/100 at baseline to 20/40) and central retinal thickness (from a mean of 534 µm at baseline to 318 µm) and with no recurrence of macular edema in most cases, without the need for further treatment. In addition, no anterior migration of the FAc implant or ocular hypertension was observed. This procedure effectively reduced the therapeutic burden for these patients. Although scleral fixation of the FAc implant has been described in small series of patients with successful results, this approach remains off-label. Conclusions: Although off-label, ITC of the FAc implant may offer a promising treatment option for patients who would otherwise remain untreated. Full article

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life. Full article

Objectives: The objective of this study was to assess the tissue response and strength of traditional and unidirectional suture materials, depending on the conditions of use and the timing following implantation. Methods: Eighty male Wistar rats were randomly assigned to four groups depending on the suture used: unidirectional absorbable V-loc^TM 180 or non-absorbable V-loc^TM PBT and traditional absorbable Maxon^TM or non-absorbable Novafil^TM. Three and six weeks following the closure of the abdominal wall defect (AWD) and subcutaneous suture implantation at the withers according to group assignment, 10 animals from each group were euthanized for implanted sutures mechanical testing and histological examination. Results: The inflammatory reaction in the AWD closure area was maximal and significantly different from the subcutaneous implantation by week 3 for all groups. At six weeks, the tissue reaction did not depend on the place of implantation. However, four rats from the Maxon^TM group demonstrated suture failure with diastasis formation. Non-absorbable barbed sutures exhibited an absence of suture failure and the maximum scar thickness. Both intact absorbable materials (V-Loc^TM 180 and Maxon^TM) exhibited a significant breaking strength margin over the non-absorbable. By week 6, the preserved strength of the V-loc^TM 180 sutures at the AWD was 33% (15–58%), and under the skin—49.7% (48–59%) (p = 0.005). For Maxon^TM, these values were 38% (35–48%) for the AWD and 44% (34–49%) for the subcutaneous implantation. Conclusions: Absorbable and non-absorbable suture materials, depending on the conditions and timing of implantation, cause various tissue reactions which could affect the wound healing and the number of postoperative complications. Full article

Suture anchors (SAs) are medical devices used to connect soft tissue to bone. Traditionally these were made of metal; however, in the past few decades, bio-absorbable suture anchors have been created to overcome revision surgeries and other complications caused by metallic SAs. This systematic review aims to analyze the biomechanical properties of these SAs to gain a better understanding of their safety and utilization. A comprehensive systematic review that adhered to the PRISMA guidelines was conducted. Primary outcomes were that the pull-out strength of SAs, the rate of degradation secondarily, and the biocompatibility of all SAs were analyzed. After screening 347 articles, 16 were included in this review. These studies revealed that the pull-out strength of bio-absorbable SAs was not inferior to that of their non-absorbable comparatives. The studies also revealed that the rate of degradation varies widely from 7 to 90 months. It also showed that not all absorbable SAs were fully absorbed within the expected timeframe. This systematic review demonstrates that existing suture anchor materials exhibit comparable pull-out strengths, material-specific degradation rates, and variable biocompatibility. All-suture anchors had promising results in biocompatibility, but evidence fails to identify a single most favorable material. Higher-powered studies that incorporate tissue-specific characteristics, such as rotator cuff tear size, are warranted. To meet demonstrated shortcomings in strength and biocompatibility, we propose silk fibroin as a novel material for suture anchor design for its customizable properties and superior strength. Full article

Resorbable medical devices provide temporary functionality before degrading into safe byproducts. One application is absorbable inferior vena cava filters (IVCFs), which prevent pulmonary embolism in high-risk patients with contraindications to anticoagulants. However, current absorbable IVCFs are limited by radiolucency and local clot formation risks. This study aimed to develop radiopaque, drug-loaded resorbable IVCFs with enhanced imaging and therapeutic capabilities. Poly-p-dioxanone (PPDO) sutures were infused with gadolinium nanoparticles (GdNPs) and dipyridamole (DPA), an anti-thrombotic agent. GdNPs were synthesized with an average diameter of 35.76 ± 3.71 nm. Gd content was 371 ± 1.6 mg/g (PPDO-Gd) and 280 ± 0.3 mg/g (PPDO-Gd + DPA), while the DPA content was 18.20 ± 5.38 mg/g (PPDO-DPA) and 12.91 ± 0.83 mg/g (PPDO-Gd + DPA). Suture thickness (0.39–0.49 cm, p = 0.0143) and melting temperature (103.61–105.90, p = 0.0002) statistically differed among the different groups, while load-at-break did not (4.39–5.38, p = 0.2367). Although suture thickness and melting temperatures differed significantly, load-at-break was preserved and did not alter the mechanical and degradation properties of the various IVCFs. Micro-computed tomography revealed enhanced radiopacity for Gd-containing IVCFs (2713 ± 105 HU for PPDO-Gd, 1516 ± 281 HU for PPDO-Gd + DPA). Radiopacity decreased gradually over 10–12 weeks. Clot-trapping efficacy was maintained, and no hemolysis or cellular toxicity was observed. In conclusion, the GdNP- and DPA-infused PPDO IVCFs demonstrated improved radiopacity, anti-thrombotic potential, and compatibility with routine imaging, without compromising mechanical strength or safety. Full article

Sutures provide mechanical support for wound closure after various traumas and surgical operations. Absorbable sutures are increasingly favored as they eliminate the need for secondary procedures and minimize additional damage to the wound site. In this study, chitosan sutures were produced using the dry jet–wet spinning method, achieving number 7-0 sutures (approximately 76 μm diameter) with a homogeneous surface. FTIR analysis demonstrated molecular interactions between chitosan and TiO₂ or curcumin, confirming successful incorporation. The addition of 3% TiO₂ increased the tensile strength of chitosan sutures by 12.32%, reaching 189.41 MPa. Morphological analysis revealed smooth surfaces free of pores and bubbles, confirming the production of high-quality sutures. Radical scavenging activity analysis showed that curcumin-loaded sutures exhibited 43% scavenging ability after 125 h, which was significantly higher compared to pure chitosan sutures. In vitro antibacterial tests demonstrated that curcumin-loaded sutures provided 98.87% bacterial inactivation against S. aureus within 24 h. Additionally, curcumin release analysis showed a cumulative release of 77% over 25 h. The bioactivity of the sutures was verified by hydroxyapatite layer formation after incubation in simulated body fluid, supporting their potential for tissue regeneration. These findings demonstrate that TiO₂ reinforcement and curcumin loading significantly enhance the functional properties of chitosan sutures, making them strong candidates for biocompatible and absorbable surgical applications. Full article

This study draws upon bio-inspiration from anatomical sutures found in hard structures, such as turtle shells, to explore if impact energy can be dissipated through geometric parameterization rather than relying on energy-absorbing materials. While previous finite element analysis studies identified optimal dovetail suture geometries for maximizing the global stiffness and toughness of archway structures, this paper explores how different suture geometries might optimize localization effects through segmentation to isolate damage caused by the propagation of strain energy. We compare the global toughness of each suture geometry to its scaling factor, defined as the ratio of strain energy in the center segment(s) of the archway over the total strain energy absorbed during deformation, normalized by the expected strain energy consistent with uniform volumetric distribution. Our findings indicate that the scaling factor tended to correlate positively with global toughness, suggesting that suture geometries that performed well globally would also exhibit the localization effect. However, there is some nuance in selecting suture geometries that perform well for both metrics, as well as ensuring that geometries that perform well for one type of segmentation are still structurally sound in others, due to little control over where impact may occur, relative to the location of a suture, in real scenarios. Full article

Background/Objectives: The huge concerns associated with biofilm-related infections in surgical procedures, along with the antibiotic resistance demonstrated by an increasing number of bacteria, have highlighted the need for alternative and effective prevention approaches. The aim of this research was to develop novel antimicrobial coatings on surgical sutures for the prevention of surgical site infections through nanotechnology-based methods. Results: The results demonstrated that although very low amounts of silver precursor were adopted for the treatments, the silver coating was effective against Staphylococcus aureus and antibiotic-resistant Pseudomonas aeruginosa in reducing the potential risk of infection. Methods: Nanostructured silver coatings were deposited onto the surface of polyglactin 910 absorbable braided sutures through a technology based on a photo-assisted chemical reaction. The materials were characterized in order to verify the efficacy of the coating in preventing biofilm formation and in reducing the bacterial colonization of the device. Conclusions: As a broad-spectrum antimicrobial agent, silver represents an important option for the prevention and management of surgical site infections. The silver deposition technology adopted in this work provides an interesting strategy for preventing biofilm formation on medical devices such as surgical sutures. Full article

Background: A tracheoesophageal fistula (TEF) represents a condition characterized by abnormal communication between the gastrointestinal tract and the airways. Although the current gold-standard treatment is surgery, pre-existing clinical conditions may represent contraindications. We therefore propose a bronchoscopic approach through rigid bronchoscopy without tracheostomy for total repair in patients suffering from benign tracheoesophageal fistulas. Methods: Fistula suture through rigid bronchoscopy with either absorbable (Vycryl 3.0, Ethicon, Inc.) or non-absorbable (Prolene, Ethicon US, LLC. 2022.) sutures was performed using a long needle holder as an alternative resolutive procedure to surgery. From 2015 to 2022, we retrospectively reviewed 10 consecutive patients affected by TEFs in our Endoscopic Unit at San Camillo-Forlanini Hospital (Rome, Italy) who underwent this bronchoscopic procedure. The coprimary outcomes were the proportion of fistulas successfully treated with the innovative treatment proposed and the rate of procedure-related complications. Results: The complete healing of the fistula was achieved in nine of the ten patients after 1 year. Follow-up with flexible bronchoscopy was scheduled and carried out at 1, 3, and 12 months following rigid bronchoscopy. Overall, seventeen endoscopic repair procedures were performed. Five of these patients required more than one endoscopic treatment to reach complete fistula closure. Fistula closure was not achieved post-procedure in one patient. No complications during procedures or in the follow-up period were reported. Conclusions: Despite the small cohort, our preliminary study has demonstrated that the endoscopic approach through rigid bronchoscopy, without tracheostomy, represents a safe and satisfactory alternative for patients affected by TEFs who are not suitable for surgery. Full article

Background and Objectives: The purpose of this case report is to examine the management of vestibular bone fenestration during alveolar socket preservation using the Periosteal Inhibition (PI) approach. Here, for the first time, the PI technique, which has been shown to be successful in maintaining intact cortical bone, is examined in the context of a bone defect. Materials and Methods: After an atraumatic extraction of a damaged tooth, a vestibular bone fenestration was discovered in the 62-year-old male patient. To shield the defect, a non-resorbable PTFE membrane (OSSEO GUARD by Zimmer Biomet) was positioned between the mucosa and the fenestration site. A resorbable porcine gelatin sponge (SPONGOSTAN^TM) was used to achieve hemostasis, and a 5/0 PGCL absorbable suture was used to close the wound. A CBCT scan was performed, and a dental implant was inserted after 4 months. Results: After 4 months, the case demonstrated positive results, with full cortical remodeling and preservation of the original bone proportions. The fenestration completely healed, proving that the PI approach works even in the presence of bone flaws in cortical bone that is still intact. Conclusions: This is the first case report that shows that vestibular bone fenestration can be successfully treated with the PI approach. It has now been demonstrated that the procedure, which hitherto needed an undamaged cortical bone to work, can help bone abnormalities to repair completely. These results imply that the PI technique is a flexible and useful approach that provides predictable results in dental surgery for treating different types of alveolar bone abnormalities. Its use might be expanded with more study to include bone dehiscence treatment. Full article

Regenerated cellulose fibers are a highly adaptable biomaterial with numerous medical applications owing to their inherent biocompatibility, biodegradability, and robust mechanical properties. In the domain of wound care, regenerated cellulose fibers facilitate a moist environment conducive to healing, minimize infection risk, and adapt to wound topographies, making it ideal for different types of dressings. In tissue engineering, cellulose scaffolds provide a matrix for cell attachment and proliferation, supporting the development of artificial skin, cartilage, and other tissues. Furthermore, regenerated cellulose fibers, used as absorbable sutures, degrade within the body, eliminating the need for removal and proving advantageous for internal suturing. The medical textile industry relies heavily on regenerated cellulose fibers because of their unique properties that make them suitable for various applications, including wound care, surgical garments, and diagnostic materials. Regenerated cellulose fibers are produced by dissolving cellulose from natural sources and reconstituting it into fiber form, which can be customized for specific medical uses. This paper will explore the various types, properties, and applications of regenerated cellulose fibers in medical contexts, alongside an examination of its manufacturing processes and technologies, as well as associated challenges. Full article

Background and Objectives: This study evaluated the outcomes of single open-flap debridement, open-flap debridement (OFD) plus resorbable membrane placement, and OFD with resorbable membrane placement plus platelet-rich fibrin (PRF) in terms of periodontal clinical parameters and glycated hemoglobin (HbA1c) levels in 24 adult patients with stage 3 grade C periodontitis and type II diabetes mellitus. Materials and Methods: The primary outcome measure for this study was the clinical attachment level (CAL); secondary outcomes included additional periodontal parameters, such as the plaque index (PI), bleeding on probing (BOP), probing depth (PD), as well as glycated hemoglobin (HbA1c) levels to evaluate the systemic impact of the treatments on glycemic control. The parameters were assessed before and at three and six months post-surgery. In Group A, the flap was sutured closed; in Group B, an absorbable collagen membrane was placed over the defect; and in Group C, PRF was utilized in the defect, with two additional PRF membranes used to cover the defect. The wound healing index (WHI) was recorded at 7 and 14 days after the surgery. Results: The initial findings indicated no significant differences in the periodontal parameters among the three groups. However, improvements in the PD and CAL were most notable in Group C, followed by Group B, with Group A showing the slightest improvement. At six months, there was a highly significant difference in the CAL (p < 0.001). Group C (4.92 ± 0.35) and Group B (4.99 ± 0.31) demonstrated the most significant improvements in the CAL compared to Group A (5.89 ± 0.57). At seven days post-surgery, Group C demonstrated significant healing, with 85% of the sites showing complete healing. By the 14-day mark, all sites in Group C indicated complete healing. Although the HbA1c values did not exhibit statistically significant differences among the groups at baseline, at the 6-month evaluation, all groups showed significantly lower values than baseline. However, the comparison between groups revealed significantly improved values for Group C. Conclusions: The study’s results suggest that PRF is an exceptional material for infrabony defects treatment and notably improves HbA1c levels. Full article

This study investigates the degradation of six different types of absorbable surgical threads commonly used in clinical practice, focusing on their response to exposure to physiological fluids. The threads were subjected to hydrolytic and enzymatic degradation in physiological saline, bile, and pancreatic juice. Our findings demonstrate that bile and pancreatic juice, particularly when contaminated with bacterial strains such as Escherichia coli, Klebsiella spp., and Enterococcus faecalis, significantly accelerate the degradation process. Using Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and tensile strength testing, we observed distinct differences in the chemical structure and mechanical integrity of the sutures. Principal component analysis (PCA) of the FTIR spectra revealed that PDS threads exhibited the highest resistance to degradation, maintaining their mechanical properties for a longer duration compared with Monocryl and Vicryl. These results highlight the critical role of thread selection in gastrointestinal surgeries, where prolonged exposure to bile and pancreatic juice can compromise the suture integrity and lead to postoperative complications. The insights gained from this study will contribute to improving the selection and application of absorbable threads in clinical settings. Full article

Surgical sutures play a crucial role in wound closure, facilitating the tissue-healing process across various fields of medicine. The objective of this study was to analyse the impact of seasoning time during the initial days/weeks of seasoning in Ringer’s solution on the mechanical properties of five commercial absorbable sutures: SafilQuick+^®, Novosyn^®, MonosynQuick^®, Monosyn^® and Monoplus^®, each with different absorption periods. The results demonstrated that the SafilQuick+ and MonosynQuick sutures lost strength within 9–12 days, as evidenced by statistically significant changes in tensile strength. In contrast, the Novosyn and Monoplus sutures did not exhibit significant changes in strength during the study period. Statistical analysis confirmed significant differences in the behaviour of the individual sutures, highlighting the importance of selecting appropriate suture material in the context of the specific medical procedure. Full article

Sutures are natural or synthetic biomaterials utilized to hold tissues together. Following oral surgery, the surgical site and sutures are physically affected by many different factors. This study was conducted to evaluate the effect of artificial saliva (AS) and chlorhexidine mouthwash on the tensile strength of absorbable multifilament PGLA (polyglycolide-co-l-lactide) and non-absorbable multifilament silk sutures. PGLA and silk sutures, which are commonly used in oral surgery, were used to evaluate the change in strength of the sutures. A total of 352 suture samples were divided into eight equal groups (n = 44) and used for the experiments. Tensile strength was tested on days 0, 3, 7, and 14. For the silk sutures, there was a significant decrease in tensile strength in all groups at time T3 compared to T0, T1, and T2, and at times T1 and T2 compared to T0. For PGLA sutures, there was a significant decrease in all groups at time T3 compared to T0, T1, and T2. This study shows that chlorhexidine mouthwash significantly reduces suture resistance for 14 days after surgery. Full article