A prospective randomized comparative study of rapidly absorbing polyglactin 910 versus chromic catgut for episiotomy repair at tertiary care hospital Bikaner, Rajasthan

Background: The aim of our study was to compare rapidly absorbing polyglactin 910 with chromic catgut as a suture material for episiotomy repair, in relation to post episiotomy complications and maternal morbidity.Methods: This prospective, randomized, comparative study of rapidly absorbing polyglactin 910 versus chromic catgut for episiotomy repair was conducted in the department of obstetrics and gynaecology, PBM hospital, associated with Sardar Patel medical college Bikaner, Rajasthan.Results: RAPG-910 was associated with significantly lesser analgesic dose requirement for pain relief than chromic catgut. Use of chromic catgut was associated with a higher incidence of hematoma formation, wound gaping, need of re-suturing of wound and need of re-admissions for management of post-episiotomy complications than RAPG-910 although, the difference was statistically insignificant. RAPG-910 was associated with better wound condition & healing as compared to chromic catgut.Conclusions:To conclude, rapidly absorbing polyglactin 910 was better than chromic catgut in relation to post episiotomy complications and maternal morbidity with a significantly lesser incidence and severity of post episiotomy pain, lesser dose of analgesia required, lesser wound gaping and infection, better wound healing, faster suture reabsorption.

Use of Polyamide (Nylon) Cable Ties for Vascular Ligation of Healthy Equine Jejunal Mesentery

Jejunal vascular ligation is an essential step in performing jejunojejunostomy. Hand sewn ligation is typically used and can increase operative time with long sections of bowel to be removed. Nylon cable ties (NCT) have been used for vascular ligation in horses but are yet to be investigated for application on the mesenteric vasculature of the gastrointestinal tract. Our objective was to evaluate the efficacy and short-term safety of NCT jejunal mesenteric vessel ligation in healthy horses. Eight healthy adult horses underwent midline celiotomy. A segment of jejunal mesentery was identified (≥4 arcades). Briefly, three fenestrations (proximal, middle, distal) were made 5–10 mm apart adjacent to the first and last vascular arcade to be ligated. Two sterilized NCT were passed to encircle the mesentery through the proximal and middle fenestrations, separated by intact mesentery. NCT were closed tightly and the vascular pedicle transected with Mayo scissors through the distal fenestration. Jejunojejunostomy was then performed and the mesentery sutured closed. The number of vascular arcades and time to ligate using NCT were recorded. At 2 weeks, horses underwent repeat celiotomy to assess the healing of the NCT ligation site and an equal number of vascular arcades were hand sewn double ligated using 2-0 Polyglactin 910 as a timed comparison. NCT mesenteric ligation was significantly faster than hand sewn methods (P < 0.01). Effective hemostasis was achieved in all cases. There was no evidence of local infection or adhesions at 14 days post-operatively. Further investigation in the long-term effects in horses as well as horses with strangulating jejunal lesions are needed for clinical application.

Bacterial Colonization on Different Suture Materials Used in Oral Implantology: A Randomized Clinical Trial

Objectives: This study aimed to compare the colonization of Enterococcus faecalis (E. faecalis), Escherichia coli (E. coli), Streptococcus mutans (S. mutans) and Staphylococcus aureus (S. aureus) isolated from the oral cavity on different suture materials used in oral implantology. Materials and Methods: Patients scheduled for implant surgery were included in this study. After flap approximation, the surgical site was sutured using silk, nylon, polyglactin 910 (Vicryl®) and triclosan-coated polyglactin 910 (Vicryl® Plus) sutures in a randomized order. Seven days after surgery, the sutures were removed and incubated in bile esculin agar (for E. faecalis), MacConkey agar (for E. coli), mitis salivarius agar (for S. mutans), and mannitol salt agar (for S. aureus) at 37°C for 24 h. The colonies were then counted. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. Results: Vicryl® sutures showed the highest accumulation of E. faecalis, followed by Vicryl® Plus, nylon, and silk. There was no significant difference between nylon and silk (P=0.5) or between Vicryl® and Vicryl® Plus (P=0.4). Vicryl® Plus sutures showed the highest accumulation of E. coli followed by Vicryl®, silk and nylon (P<0.01). Vicryl® sutures showed the highest accumulation of S. mutans, followed by Vicryl® Plus, silk, and nylon. Vicryl® Plus sutures showed the highest accumulation of S. aureus, followed by Vicryl®, nylon, and silk. Conclusion: Nylon sutures showed the least microbial accumulation. Vicryl® and triclosan-coated Vicryl® Plus sutures had no advantage over the commonly used silk sutures in decreasing the number of bacteria.

Polyglactin 910 (Vicryl Rapide) for Reducing Pain and Wounds Healing in Postpartum Perineum

Objective: The purpose of this study was to compare the use of polyglactin 910 (vicryrapide) and chromic catgut to perineal pain and healing wounds on postpartum. Method: This research is true experiment with a randomized controlled trial (RCT) and single-blind. The number of respondents pad this study of 40 respondents were divided into 20 respondents to the intervention group (vicrylrapide) and 20 respondents for the control group (chromic catgut). Data analysis using independent t-test. Results: Statistical test results using independent t-test for pain showed p = 0.035 <0.05 and for wound healing showed p = 0.000 <0.05 of a second can mean the results are there differences in the use of threads polyglactin 910 (vicrylrapide) and chromic catgut thread to perineal pain and healing wounds in the mother postpartum perineum. Conclusion: The use rapidevicryl thread to repair perineal perineum or stitches can reduce perineal pain and healing wounds better than the use of the chromic catgut thread. Keywords: chromic catgut, pain, polyglactin 910, rapide vicryl, wound healing of the perineum. Abstrak Tujuan: Untuk mengetahui perbandingan penggunaan polyglactin 910 (vicry rapide) dan chromic catgut terhadap nyeri dan penyembuhan luka perineum pada postpartum. Metode: Penelitian ini merupakan penelitian true experiment dengan randomized controlled trial (RCT) dansingle blind. Jumlah responden pada penelitian ini sebanyak 40 responden yang di bagi menjadi 20 responden untuk kelompok intervensi (vicryl rapide) dan 20 responden untuk kelompok kontrol (chromic catgut ). Analisis data menggunakan independent t-test. Hasil: Uji statistik menggunakan independent t-test untuk nyeri didapatkan hasil p=0,035<0,05 dan untuk penyembuhan luka didapatkan hasil p=0,000<0,05 dari kedua hasil tersebut dapat diartikan ada perbedaan penggunaan benang polyglactin 910 (vicryl rapide) dan benang chromic catgutterhadapnyeri perineum dan penyembuhan luka perineum pada ibu postpartum. Kesimpulan: Penggunaan benang vicryl rapide untuk perbaikan perineum atau penjahitan luka perineum dapat mengurangi nyeri perineum dan penyembuhan luka yang lebih baik dibandingkan dengan penggunaan pada benang chromic catgut. Kata kunci: chromic catgut, nyeri, penyembuhan luka perineum, polyglactin 910, vicryl rapide.

How to tie dangerous surgical knots: easily. Can we avoid this?

ObjectiveSecure knots are essential in all areas of surgical, medical and veterinary practice. Our hypothesis was that technique of formation of each layer of a surgical knot was important to its security.DesignEqual numbers of knots were tied, by each of three groups, using three techniques, for each of four suture materials; a standard flat reef knot (FRK), knots tied under tension (TK) and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and tested by distraction with increasing force, till each material broke or the knot separated completely.SettingTemporary knot tying laboratory.MaterialsThe suture materials were, 2/0 polyglactin 910 (Vicryl), 3/0 polydioxanone, 4/0 poliglecaprone 25 (Monocryl) and 1 nylon (Ethilon).ParticipantsThree groups comprised, a senior surgeon, a resident surgeon and three medical students.Outcome measuresProportion of each knot type that slipped, degree of slippage and length of suture held in loop secured by each knot type.Results20% of FRK tied with all suture materials slipped; all knots tied with the other two techniques, with all materials, slipped, TK (100%) and NHCK (100%). The quantitative degree of slip was significantly less for FRK (mean 6.3%–, 95% CI 2.2% to 10.4%) than for TK (mean 312%, 95% CI 280.0% to 344.0%) and NHCK (mean 113.0%, –95% CI 94.3% to 131.0%).The mean length of suture in loops held within (FRK mean 25.1 mm 95% CI 24.2 to 26.0 mm) was significantly greater than mean lengths held by the other techniques (TK mean 17.0 mm, 95% CI 16.3 to 17.7 mm), (NHCK mean 16.3 mm, 95% CI 15.9 to 16.7 mm). The latter two types of knot may have tightened more than anticipated, in comparison to FRK, with potential undue tissue tension.ConclusionMeticulous technique of knot tying is essential for secure knots, appropriate tissue tension and the security of anastomoses and haemostasis effected.

How to tie dangerous surgical knots - easily. Can we avoid this?

E H Drabble**, S Spanopoulou*, E. Sioka*, E Politaki*, I K Paraskeva*, E Palla*, L Stockley***, D Zacharoulis* (* University of Thessaly, Greece, **Clinical lead BSS course RCS England, Consultant Surgeon, University of Plymouth Hospitals NHS Trust***University of Plymouth, England) (Data statement: 'Technical appendix, statistical code, and dataset available from the Univrersity of Plymouth Data repositry Corresponding author: Eric Drabble, c/o 42 Skylark Rise, Plymouth PL6 7SN, Devon, UK [email protected] +44 7533 186772 Abstract Objective: Secure knots are essential. Previous publications have concentrated on security of different knot types, but could individual technique be important? Determine whether the technique of formation of each layer of a surgical knot is important to the security of the knot formed. Design study: Prospective analysis of technique on knot security Materials and methods: Senior and resident surgeons, and medical students, tied knots with three techniques, using four study materials, 2/0 polyglactin 910 (vicryl), 3/0 polydioxanone (PDS), 4/0 poliglecaprone 25 (monocryl) and 1 nylon (Ethilon); a standard flat reef knot (FRK), knots tied under tension (TK), and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and security determined by distraction with increasing force, till each material broke, or the knot separated completely. Results: 20% of flat reef knots (FRK) tied with all suture materials slipped; all knots tied with the other two techniques, with all materials, slipped, TK (100%) and NHCK (100%). The quantitative degree of slip, was significantly less for FRK (mean 6.3% 95%CI 2.2-10.4%) than for TK (mean 312% 95%CI 280.0-344.0%) and NHCK (mean 113.0% 95%CI 94.3-131.0%). The mean lengths of suture in loops held within knots, tied under tension (TK mean 17.0mm 95%CI 16.3-17.7mm), and tied without appropriate hand crossing (NHCK mean 16.3mm 95%CI 15.9-16.7mm) were significantly lower than for flat reef knots (FRK mean 25.1mm 95%CI 24.2-26.0mm). The first two types of knot may have tightened more than anticipated, in comparison to flat reef knots, with potential undue tissue tension. Conclusion: Meticulous technique of knot tying, is essential for secure knots, appropriate tissue tension, and the security of anastomoses and haemostasis effected