Search Results (81)

A 10-year-old castrated male Chihuahua weighing 3.06 kg was presented with a chronic, progressively worsening cough of five months’ duration. Diagnostic imaging, including thoracic radiography and computed tomography, identified a well-defined cranial mediastinal mass consistent with a thymic tumor. Surgical excision was performed via median sternotomy with complete thymectomy. Following tumor removal, sternal closure was achieved using a non-absorbable ultra-high-molecular-weight polyethylene (UHMWPE) suture material (FiberWire^®, Arthrex, Naples, FL, USA). Histopathological examination confirmed the diagnosis of an epithelial-predominant thymoma with narrow but complete surgical margins. Postoperative recovery was uneventful, and the dog was discharged three days after surgery. Clinical signs, including coughing, progressively improved during follow-up. Radiographic evaluation performed up to postoperative day 57 demonstrated stable sternal alignment without evidence of dehiscence, implant-related complications, or disease recurrence. This report describes the first clinical case of FiberWire use for median sternotomy closure following thymectomy in a dog. The favorable clinical and radiographic outcomes observed during postoperative follow-up suggest that FiberWire may represent a viable alternative to traditional stainless-steel wire for sternal fixation in canine thoracic surgery. Full article

Background: Surgical site infection (SSI) remains a major concern in pediatric urological reconstructive surgery. Antibacterial-coated absorbable sutures like Monocryl Plus^® have been introduced to reduce SSI, but evidence in pediatric populations is limited. This study aimed to compare outcomes between Monocryl^® and Monocryl Plus^® sutures in common pediatric urological procedures. Methods: A retrospective review was conducted of all children who underwent reconstructive urological surgery for hydronephrosis, vesicoureteral reflux (VUR), or hypospadias at the University Hospital of Split between January 2008 and December 2025. A total of 653 patients were included: 149 with hydronephrosis, 187 with VUR, and 317 with hypospadias. Patients were grouped based on suture type (Monocryl^® vs. Monocryl Plus^®). The primary outcome was SSI within 30 days after surgery; secondary outcomes included overall complications, reoperations, readmissions, and length of hospital stay. Results: SSI occurred less frequently with Monocryl Plus than with Monocryl (3.8% vs. 6.9%, p = 0.04). The median length of stay was shorter in the Monocryl Plus group (5 days, IQR 4–7) compared to Monocryl (6 days, IQR 5–8; p = 0.02). Overall complication rates were 6.1% vs. 10.0% (p = 0.07), early complications 4.6% vs. 8.0% (p = 0.06), and late complications 2.3% vs. 4.2% (p = 0.18), favouring Monocryl Plus but without statistical significance. Reoperation was required in 1.8% vs. 3.4% (p = 0.19), and readmission in 2.6% vs. 5.0% (p = 0.12). Subgroup analysis showed minimal differences in hydronephrosis (all p > 0.6), modest reductions in VUR (SSI 8.1% vs. 4.4%, p = 0.21), and significant differences in hypospadias (SSI 7.8% vs. 4.2%, p = 0.04; fistula 12.2% vs. 6.5%, p = 0.03). Multivariate regression confirmed Monocryl Plus as independently associated with lower odds of SSI (OR 0.55, 95% CI 0.30–0.98, p = 0.04) and prolonged hospitalization >7 days (OR 0.59, 95% CI 0.38–0.91, p = 0.02). Conclusions: In pediatric urological reconstructive surgery, Monocryl Plus sutures were associated with significantly fewer SSIs and shorter hospital stays compared to traditional Monocryl. Although the overall complication, reoperation, and readmission rates showed nonsignificant trends favouring Monocryl Plus, the most notable benefits appeared in hypospadias repair, suggesting that suture choice might influence outcomes in this subgroup. Full article

This study aimed to evaluate the mechanical stability of suture materials following exposure to different toothpaste formulations during the early stages of wound healing. Absorbable and non-absorbable suture materials were tested and each suture was tied with five knots on silicone rods. Four different toothpastes and artificial saliva (control) were used. Sutures were exposed to the toothpastes at specific times on certain days, and stored in artificial saliva. Artificial saliva was used to simulate the oral environment. The study duration was 14 days. Tensile strength was tested on selected days throughout a 14-day period. All sutures showed a gradual reduction in tensile strength over time. The least tensile strength reduction was in the artificial saliva group, while most suture degradation was seen in whitening toothpaste group, particularly in absorbable sutures. The findings of this study show that chemical components in certain toothpaste formulations may degrade the sutures during healing. Within the limitations of this in vitro study, the use of the whitening toothpaste group during early wound healing may warrant careful consideration in situations where wound stability is critical. Full article

Background/Objectives: Conjunctival closure may influence early postoperative comfort and wound healing after pediatric strabismus surgery. We compared fibrin glue with absorbable sutures using anterior segment optical coherence tomography (AS-OCT)-based conjunctival thickness, serial clinical scores, ocular-surface screening, and operative time. Methods: We retrospectively reviewed 82 children (5–15 years) who underwent bilateral medial rectus recession. The conjunctiva was closed with 8-0 polyglactin 910 (Vicryl) (suture group, n = 40) or fibrin glue (fibrin group, n = 42) according to routine practice; right eyes were analyzed. Conjunctival thickness was measured by AS-OCT preoperatively and at week 6. The comfort questionnaire (CQ) score and inflammation score (IS) were recorded on postoperative day 1 and weeks 1, 2, and 6. Total operative time and closure time were obtained from surgical video recordings. Ocular Surface Disease Index-6 (OSDI-6) and non-invasive keratographic break-up time (NIKBUT) were assessed preoperatively and at week 6 in cooperative children (n = 62). Results: Conjunctival thickness increased in both groups and was slightly higher at week 6 with sutures (p < 0.001), with a slightly greater percentage increase (p = 0.001). CQ and IS were worse with sutures through week 2 (all p < 0.05) and converged by week 6 (both p > 0.05). Fibrin glue shortened total operative time (32.75 vs. 35.46 min; p < 0.05) and closure time (3.90 vs. 5.35 min; p < 0.001). In the ocular-surface subset, OSDI-6 and NIKBUT did not differ between groups at week 6. No infections or granulomas occurred; two early conjunctival wound gaps occurred in the fibrin group and one resolved with topical management, while the other met the dehiscence definition (≥2 mm) and required re-suturing, and both healed without sequelae. Conclusions: In pediatric strabismus surgery, fibrin glue demonstrated better early comfort with a modest difference in conjunctival thickness at week 6 along with slightly shorter operative time while clinical scores converged by week 6, and ocular-surface screening outcomes were similar. Full article

Non-absorbable sutures provide a site for bacterial attachment and increase the risk of surgical site infections. An alternative prevention of infections requires plant-extract coatings on sutures. The objectives of this study were to develop P. betle leaf extract-coated non-absorbable sutures and to investigate their activities on staphylococci. P. betle leaves were extracted and analyzed for the phytochemicals. P. betle extract was coated on sutures, including polyester and polypropylene. The stability of hydroxychavicol on coated sutures was evaluated. Four treatments were designed, including (1) uncoated, (2) antibiotic/extract-free-coated, (3) extract-coated, and (4) gentamicin-coated sutures. Each treatment was tested for antibacterial, antibiofilm, and anti-adhesion activities on Staphylococcus aureus and Staphylococcus pseudintermedius. In addition, the cytotoxicity of extract-coated sutures was tested. Analysis of the extract identified hydroxychavicol (40.07%) as the primary phytochemical. Stability tests indicated higher hydroxychavicol on Day 1 of extract-coated polyester compared to polypropylene, and the levels decreased on the subsequent days (p < 0.05). Antibacterial activity of extract-coated polyester showed antibacterial effects during the experiment period (5.16 ± 2.35 mm), while polypropylene showed no effectiveness. Additionally, biofilm inhibition was found to be 36.63 ± 27.08% and 37.34 ± 26.98% in tested staphylococci for extract-coated polyester and polypropylene, respectively. Anti-adhesion showed that the extract-coated sutures had a higher ability to decrease tested bacteria attachment (56.25–60.42% living cell reduction). The cytotoxicity study revealed that extract-coated sutures of ≤1.5 mg/1.5 cm had a 99% survival rate. The findings indicate that the coated sutures showed antibacterial, antibiofilm, and anti-adhesion effects against staphylococci causing canine skin infections and might lead to alternative surgical use in veterinary medicine. Full article

Background/Objectives: Incisional hernia (IH) is a frequent complication after kidney transplantation, with its risk influenced by both patient-related factors such as obesity, diabetes mellitus, and smoking, and procedure-related factors including surgical technique and immunosuppressive therapy. This study aimed to identify risk factors associated with IH and to evaluate the impact of suture type used for fascial closure in kidney transplant recipients. Methods: We performed a single-center retrospective case–control study including adult kidney transplant recipients who underwent transplantation between January 2014 and January 2024. Patients who developed an IH were identified and matched 1:6 with controls according to year of transplantation. Demographic variables, patient comorbidities, dialysis modality, and type of fascial closure suture were analyzed. Patients were subsequently compared according to the type of fascial closure used, either absorbable barbed polydioxanone sutures or absorbable monofilament polyglyconate loop sutures. Multivariable logistic regression analysis was conducted to identify independent predictors of IH. Results: Among 1586 kidney transplant recipients, 39 patients developed an IH, corresponding to an incidence of 2.5% after a median follow-up of 36 months. On multivariable analysis, age was independently associated with IH development (OR 1.04; p = 0.01), as was obesity (body mass index > 30 kg/m²; OR 2.55; p = 0.01). The overall incidence of IH did not differ significantly between suture types, with rates of 11.4% (10/88) for absorbable barbed polydioxanone sutures versus 15.6% (29/186) for absorbable monofilament polyglyconate loop sutures (p = 0.35). In obese recipients, however, fascial closure with barbed polydioxanone sutures was associated with a significantly lower incidence of IH, at 9.1% (2/22) versus 36.4% (12/33) for loop sutures (p = 0.02). Conclusions: Obesity and older age were the main independent predictors of IH after kidney transplantation in this cohort. In obese recipients, fascial closure using absorbable barbed polydioxanone sutures was associated with a substantially lower IH rate. These findings warrant confirmation in prospective, randomized studies. Full article

Peripheral nerve injuries, especially neurotmesis, require precise repair strategies due to their severity and limited capacity for spontaneous regeneration. Nerve guidance conduits (NGCs) offer a promising alternative to autografts; however, consistent surgical techniques and anatomical references in rodent models could be enhanced. This ex vivo study focuses on describing and establishing a standardized, reproducible anatomical and technical protocol for implanting an NGC in the sciatic nerve of Wistar rats, identifying a 7 mm segment free of collateral branches as a safe site for neurotmesis. Thirty cadaveric hind limbs were positioned in lateral decubitus, and anatomical landmarks such as the greater trochanter, ischial bone, and femoral condyle guided the incision. A 1 cm scaffold was inserted and secured with 8-0 absorbable sutures, while muscle and skin were closed with 5-0 and non-absorbable sutures. The technique enabled safe access to the nerve, minimized risk to adjacent structures, and ensured proper scaffold positioning without tension. This standardized approach improves surgical reproducibility and supports anatomical integrity; however, because the study used ex vivo cadaveric samples, its capacity to facilitate functional nerve regeneration remains theoretical. While the protocol emphasizes the importance of surgical planning and suture patterns, it cannot account for active biological processes such as angiogenesis, inflammatory response, or axonal growth, which are critical for successful repair. Ultimately, this study provides a reliable anatomical platform for NGC evaluation under controlled experimental conditions, serving as a necessary precursor to in vivo validation of safety and functional outcomes. Full article

Non-absorbable surgical meshes are key biomedical materials used for tissue reinforcement, designed for durability, biocompatibility, and mechanical stability in clinical applications. The mechanical properties of these meshes, such as tensile strength, elasticity, and porosity, are crucial for their long-term performance and integration with host tissue. In the context of Industry 4.0/5.0, emphasis is placed on integrating intelligent technologies, such as real-time data acquisition and advanced computational modeling, to improve the design and production of surgical meshes. Computational models simulate the mechanical behavior of meshes under physiological conditions, enabling precise optimization of their material properties and design. In this article, we propose potential artificial intelligence (AI)-based approaches for future research, such as machine learning (ML), for analyzing large datasets from computational and experimental studies to identify optimal mesh configurations. The direction of tensile loading significantly influences the mechanical response of the mesh. Transversely stretched specimens demonstrated higher maximum failure forces and greater fatigue resistance than longitudinally stretched specimens, both in sutured and unsutured conditions. Suturing the mesh to biological tissue significantly reduced its mechanical strength and stiffness, demonstrating a weakening effect at the mesh-tissue interface. Cyclic loading revealed a gradual decrease in strength in all specimens, suggesting fatigue, but transversely stretched meshes maintained higher forces for >1000 cycles than longitudinally stretched meshes. The observed differences in mechanical behavior can be attributed to the anisotropic mesh structure and mechanical suturing effects, which introduce stress concentrations and structural discontinuities. These results emphasize the importance of considering both directionality and surgical technique when selecting and implementing mesh implants. Both AI-based models achieved scores above 80%, demonstrating their clinical utility and the potential for development toward prediction accuracy above 85–90% in clinical settings. Future research should incorporate AI-based computational models to improve predictive capabilities, ultimately leading to the development of more effective, patient-specific surgical meshes. Full article

The rapid development of ophthalmic surgery in recent years has made big steps forward, making interventions such as penetrating and lamellar keratoplasty or trabeculectomy widely practiced. However, the use of non-absorbable sutures in these procedures poses significant challenges. Indeed, unequal tension between the various stitches can lead to deformations of the cornea or lens and consequently to problems such as post-operative astigmatism or anisometropia. To overcome these problems, sutures with improved closure via a highly stretchable behaviour together with an excellent elastic return are a credible solution. Accordingly, to widen the plethora of superelastic polymeric materials, in the present study a novel solution deriving from two furan-based polyesters, poly(pentamethylene furanoate), PPeF, and poly(hexamethylene furanoate), PHF, was successfully obtained. Of note, these homopolymers are also entirely derived from sustainable sources. The two homopolymers were physically and chemically mixed to obtain copolymers with different block lengths, which were characterised from molecular, thermal, mechanical, and surface wettability points of view, showing interesting properties which were easily modulated as a function of block length. Lastly, all the materials showed good stability over time and cell viability and, for some of them, a great mechanical recovery upon deformation was also observed. Full article

Background: Necrotizing enterocolitis (NEC) is a life-threatening condition characterized by necrosis of the gastrointestinal tract caused by hypoperfusion and hypoxia-induced inflammation. Surgical treatment often requires resection, with high morbidity and mortality. Intestinal tissue engineering using absorbable biomaterials represents a potential alternative. Small intestinal submucosa (SIS) is a biodegradable extracellular matrix (ECM) scaffold that may facilitate regeneration of the native tissue. Objectives: The aim of our study is to investigate the regenerative potential of SIS in a rat model with multiple gastrointestinal defects. Methods: In rats, after a midline laparotomy, an approximately 1 cm full-thickness incision was performed on the anterior gastric wall, on the antimesenteric side of the small and large intestine, each covered with an SIS patch. After three weeks, the graft sites and adjacent fragments were harvested and fixed in 10% neutral buffered formalin. Cross-sections of the grafted area were processed and stained with hematoxylin and eosin for histologic analysis. Results: Among the fifteen Wistar rats used in the study, the survival rate was 80% (12/15). Macroscopic examination of the abdominal cavity after the second surgery showed no complications. Adhesions were present in 92% (11/12). Histological examination demonstrated complete mucosal coverage in all stomach samples, nine of the small intestine, and ten of the large intestine. Mild fibrosis with minimal inflammatory infiltrates predominated. Ulceration with granulation tissue replacement was observed in three small intestine samples. Foreign body reactions were restricted to suture sites. Conclusions: In this multifocal injury model, SIS integrated effectively and supported early regenerative healing across gastric, small-intestinal, and colonic sites at 3 weeks. These data support further studies with longer follow-up, quantitative histology and functional assessment, and evaluation in neonatal-relevant large animal models to determine translational potential for NEC surgery. Full article

Myocardial hypoxia is a major cause of cardiac dysfunction, triggering cellular injury and apoptosis. This study aims to investigate the effects of subacute hypoxia on cardiac remodeling and mitochondrial oxygen consumption. This study is based on a rabbit experimental model. Hypoxia was induced using a rabbit tracheal stenosis model. Endotracheal intubation with a 1.5 cm segmented tube wrapped with an absorbable hemostat was used to generate tracheal stenosis in six rabbits. Sham controls (n = 3) underwent tracheotomy, with the tracheal exposure site being sutured immediately. After 1 week, the tube was removed. Echocardiography and mitochondrial function from both groups were morphologically and functionally analyzed at 2 weeks after endoscopic confirmation of tracheal stenosis. Compared to sham group, tracheal stenosis group showed significantly reduced interventricular septal wall thickness (2.3 ± 0.1 mm vs. 2.7 ± 0.2 mm, p = 0.08) and enlarged left ventricular end-diastolic volume (5.86 ± 0.58 mL vs. 5.39 ± 0.18 mL, p = 0.46) with reduced left ventricular ejection fraction (54.5 ± 5.3% vs. 66.9 ± 4.0%, p = 0.005). The tracheal stenosis group showed significantly reduced mitochondrial oxygen consumption at state 3 with reduced respiratory control ratio. Caspase activities (caspase-9 and caspase-3) were increased in the tracheal stenosis group than in the sham group. Subacute hypoxia induced by the tracheal stenosis model causes cardiac remodeling and mitochondrial dysfunction through apoptotic pathways. This study suggests that management of hypoxia could prevent cellular apoptosis and cardiac dysfunction. Full article

Suture materials are of pivotal importance in the process of wound healing, as they provide support to growing tissue. The application of suture materials is an intricate process that extends beyond mere closure of skin wounds. Rather, it encompasses a wide range of surgical procedures. It is evident that suture materials possess a high degree of versatility, as evidenced by their application in a broad range of surgical disciplines, including, but not limited to, plastic surgery, neurosurgery, vascular surgery and ocular surgery. Additionally, their application extends to wound treatment and the repair of the musculo-skeletal system and the urogenital tract. This review underscores the pivotal role of sutures in contemporary medicine and surgery. The selection of suture material must be made with the utmost attention to the physical and biological characteristics of the material concerned. The process is characterised by a multifaceted evaluation encompassing the following: first, the assessment of the wound in question; secondly, the healing rate of different tissue types; and thirdly, a thorough appraisal of the patient’s overall physical condition. Advances in suture material technology have given rise to a wider range of sutures, thereby enhancing the existing array of options. Simultaneously, suture needles have undergone a progressive process of technological refinement, resulting in a more comprehensive range of alternatives with a heightened level of precision for specific applications in tissue engineering. Recent experimental investigations have employed an animal model, underpinned by biomechanical analysis. It is evident from the findings of these studies that absorbable sutures fulfil a scaffolding function. The hypothesis concerning the biomimetic function of the materials under investigation was corroborated by the results of biomechanical behaviour and histological examination. This review explores the functionality of both absorbable sutures and novel polymers, investigating their potential application as scaffolding materials within clinical contexts. Full article

Background/Objectives: Surgical site infection (SSI) rates following breast surgical procedures range from 0.8% to 26%. Both prophylactic antibiotics and antimicrobial-coated sutures have been shown to play an important role in reducing these complications. This study aimed to evaluate the impact of antibiotic prophylaxis in mastectomy procedures using triclosan-coated sutures. Methods: This study included 300 consecutive patients who underwent mastectomy for breast cancer over a two-year period, during which triclosan-coated Vicryl Plus sutures were used. Patients were divided into two groups based on the use of antibiotic prophylaxis. The prophylaxis group received 1.5 g cefuroxime intravenously at anesthesia induction (600 mg clindamycin in case of allergy), while the control group received no antibiotics. Endpoints of interest included differences in SSI and specific wound-healing complications at follow-up. Results: There was no significant difference in the overall SSI rates between the two groups: 23.2% in the prophylaxis group vs. 18.8% in the control group [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.69–1.13; vs. OR: 1.16; 95% CI 0.85–1.58; p = 0.343]. No adverse drug reactions were observed. Staphylococcus aureus was the most isolated microorganism in both groups. Multivariate analysis identified prolonged operative time and hematoma formation as significant predictors of postoperative infection. Conclusions: Antibiotic prophylaxis did not reduce the rate of SSI following mastectomy for breast cancer when triclosan-coated sutures were used. Further high-quality, independent studies are warranted, particularly in breast surgery context. Full article

Background/Objectives: Soft tissues are essential for maintaining the function and long-term success of dental implants. In many cases, implant placement necessitates soft tissue augmentation procedures such as free gingival grafts (FGGs) or connective tissue grafts (CTGs) to restore lost gingival architecture. Nevertheless, a significant challenge associated with FGG and CTG is postoperative pain, largely due to morbidity at the palatal donor site. To address this issue, various approaches have been proposed to reduce patient discomfort and promote improved wound healing at the donor site. This study aimed to compare the effectiveness of four different methods for protecting the palatal donor site following free gingival graft harvesting. Methods: A total of 76 patients undergoing implant therapy with an indication for free gingival grafting were selected and divided into four groups based on the method used to protect the palatal donor site: an absorbable gelatin sponge secured with sutures (GS); an absorbable gelatin sponge with sutures and cyanoacrylate tissue adhesive (GS+CTA); oxidized regenerated cellulose combined with cyanoacrylate tissue adhesive (ORC+CTA); and an absorbable gelatin sponge covered with a flowable resin composite and stabilized with sutures (GS+FRC). The effectiveness of each method was evaluated in terms of postoperative pain, bleeding, and wound healing. Results: Although the differences in pain intensity among the groups were not statistically significant throughout the observation period (p > 0.05), the GS+FRC group consistently exhibited the lowest mean pain scores. No statistically significant differences were observed between the groups regarding the incidence of secondary bleeding. The highest mean wound healing rate was recorded in the GS+FRC group (75.95 ± 18.75%), whereas the ORC+CTA group demonstrated the lowest rate (43.66 ± 25.74%). Conclusions: The use of an absorbable gelatin sponge covered with a flowable resin composite and secured with sutures, despite the presented limitations, appears to be a promising approach for palatal wound protection. While this group consistently demonstrated the lowest mean pain scores, differences in pain intensity among the groups were not statistically significant. Nonetheless, it achieved the most favorable outcomes in terms of wound epithelialization. Full article

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