Catgut and its Use in Plastic Surgery

Knot Security 101: A Comprehensive Practical Review to Optimal Knot Configuration, Pulling Direction, Throw Count, and Tail Length

Background

Knots are the weakest structural point in a suture line and inevitably weaken almost all suture materials. This practical review critically evaluates the factors, such as suture material properties, gauge, configuration, throw count, and tail length, that affect knot security.

Methods

A PubMed search between the years 1934 and 2023 identified relevant studies that addressed factors relating to knot security. Studies that investigated knots and sutures solely used in laparoscopic and arthroscopic surgery were excluded. Knot configurations assessed were the Aberdeen, sliding, square, and surgeon's.

Results

Eighty-six articles were included in this review article and demonstrated that knot security varies greatly between suture materials and gauge. Knot security also varies by configuration, throw count, conditions, tail length, and stitch type. Throw count differs by knot configuration, with the Aberdeen knot being most secure with three throws and one to two turns compared with three to five throws for surgeon's and square knots. The optimal tail length was 3 mm.

Conclusions

This practical review demonstrates that there are significant differences in knot security based on a variety of factors. It is challenging to propose an ideal knot because most studies did not evaluate knot security using a broad variety of suture materials, gauges, and throws for each of the most common knots. Although this review article demonstrated several applicable findings, additional robust studies are needed to simplify proposals.

Gastrointestinal nematodiasis of goats in Somali pastoral areas, Ethiopia

Livestock, mainly goats, are crucial for animal protein, household income, economic security, and wealth creation in the pastoral areas of eastern Ethiopia. However, gastrointestinal parasitosis poses a substantial challenge in this sector. A cross-sectional study was conducted in the Gursum district of the Somali region, Ethiopia, to investigate the prevalence and intensity of gastrointestinal nematodes in goats and their associated risk factors. A total of 384 goat fecal samples were collected and examined using flotation and McMaster egg counting techniques for GIT nematodes. Coprological cultures have also been conducted for nematode identification. Fecal samples showed an overall parasite prevalence of 54.17%, with identified nematodes including Haemonchus (24%), Strongyloides (10.4%), Trichostrongles (6.5%), Nematodirus (6%), Oesophagostomum (5.5%) and Trichuris (1.87%). Older and poor body condition animals had higher chances of hosting nematodes than younger (OR = 0.245; CI = 0.144-0.417) and good body condition animals (OR = 0.069; CI = 0.030-0.157), according to multivariate logistic regression analysis. Quantitative examination of eggs revealed light 75(36.06%), moderate 99(47.60%), and heavy infection (n = 34, 16.35%). Analysis of the different study variables indicated that the age and body condition of the animals and the season of the year had a statistically significant association with the prevalence of GIT nematode infections (P-value <0.05). The high prevalence and intensity of GIT nematodiasis in goats from the study area warrants immediate attention and the implementation of strategic control and prevention measures.

Biocompatibility Testing for Implants: A Novel Tool for Selection and Characterization

This review article dives into the complex world of biocompatibility testing: chemical, mechanical, and biological characterization, including many elements of biocompatibility, such as definitions, descriptive examples, and the practical settings. The focus extends to evaluating standard documents obtained from reliable organizations; with a particular focus on open-source information, including FDA-USA, ISO 10933 series, and TÜV SÜD. We found a significant gap in this field: biomaterial scientists and those involved in the realm of medical device development in general, and implants in particular, lack access to a tool that reorganizes the process of selecting the appropriate biocompatibility test for the implant being examined. This work progressed through two key phases that aimed to provide a solution to this gap. A straightforward "yes or no" flowchart was initially developed to guide biocompatibility testing decisions based on the previously accumulated information. Subsequently, the Python code was employed, generating a framework through targeted questions. This work reshapes biocompatibility evaluation, bridging theory and practical implementation. An integrated approach via a flowchart and the Python code empowers stakeholders to navigate biocompatibility testing effortlessly. To conclude, researchers are now better equipped for a safer, more effective implant development, propelling the field towards improved patient care and innovative progress.

General Morphological Characteristics of the Results of Experimental Modeling of Aseptic Peritonitis

BACKGROUND

Aseptic peritonitis is a reaction of the local immune system aimed at rejection of a foreign body, which, having antigenic properties, does not (unlike a pathogen) counteract the immune system. The suture materials, namely catgut thread, used in intracavitary surgical operations possess xenogenic properties and can be used for antigenic stimulation of the immune system of the peritoneal cavity. Consequently, we decided to use a catgut suture for antigenic stimulation of the immune system of the peritoneal cavity and to study the morphological features of the results of experimental modeling of aseptic peritonitis in albino rats.

METHOD

The study involved 15 Wistar albino male rats, weighing 286,13 ± 6,26 g. To study the dynamics of destructive changes made by the catgut implant in the peritoneal cavity of the experimental animals, the animals were assigned into three groups in accordance with the time interval of their euthanasia at 3, 7, and 14 days of the experiment.

RESULTS

After modeling an aseptic peritonitis, the investigation the abdominal cavity showed that in four out of five animals of the first group, that is, on day 3 of the experiment, the catgut implant had adhered to the greater omentum. The search for the fifth implant led to an unexpected discovery: we found it conjoined with the second derivative of the visceral peritoneum, similar in structure to the greater omentum, but related to the testes. On day 7, the implant embedded into the peritoneal cavity of the animals, had adhered to the serous formations of the testes in all five cases (100%, three of them - to the left epididymal omentum, and another two - to the right one). On day 14 (n = 5) it was found that in three cases it had adhered to the serous formations of the testes (60%, one of them to the left epididymal omentum, another two - to the right one) and in two cases it had adhered to the greater omentum (40%).

CONCLUSION

During the experiment on implantation of a xenogenic substrate in the form of flat bundles made from the catgut thread into the peritoneal cavity of sexually mature male rats, it was found for the first time that their acceptors were not only the greater omentum, but also two derivatives of the peritoneum, homeomorphic to it and associated with the epididymides, which we reasonably called epididymal omenta and described in details.

Advances, challenges, and prospects for surgical suture materials

As one of the long-established and necessary medical devices, surgical sutures play an essentially important role in the closing and healing of damaged tissues and organs postoperatively. The recent advances in multiple disciplines, like materials science, engineering technology, and biomedicine, have facilitated the generation of various innovative surgical sutures with humanization and multi-functionalization. For instance, the application of numerous absorbable materials is assuredly a marvelous progression in terms of surgical sutures. Moreover, some fantastic results from recent laboratory research cannot be ignored either, ranging from the fiber generation to the suture structure, as well as the suture modification, functionalization, and even intellectualization. In this review, the suture materials, including natural or synthetic polymers, absorbable or non-absorbable polymers, and metal materials, were first introduced, and then their advantages and disadvantages were summarized. Then we introduced and discussed various fiber fabrication strategies for the production of surgical sutures. Noticeably, advanced nanofiber generation strategies were highlighted. This review further summarized a wide and diverse variety of suture structures and further discussed their different features. After that, we covered the advanced design and development of surgical sutures with multiple functionalizations, which mainly included surface coating technologies and direct drug-loading technologies. Meanwhile, the review highlighted some smart and intelligent sutures that can monitor the wound status in a real-time manner and provide on-demand therapies accordingly. Furthermore, some representative commercial sutures were also introduced and summarized. At the end of this review, we discussed the challenges and future prospects in the field of surgical sutures in depth. This review aims to provide a meaningful reference and guidance for the future design and fabrication of innovative surgical sutures. STATEMENT OF SIGNIFICANCE: This review article introduces the recent advances of surgical sutures, including material selection, fiber morphology, suture structure and construction, as well as suture modification, functionalization, and even intellectualization. Importantly, some innovative strategies for the construction of multifunctional sutures with predetermined biological properties are highlighted. Moreover, some important commercial suture products are systematically summarized and compared. This review also discusses the challenges and future prospects of advanced sutures in a deep manner. In all, this review is expected to arouse great interest from a broad group of readers in the fields of multifunctional biomaterials and regenerative medicine.

Catgut Versus Polypropylene Sutures for Transcolumellar Incision Closure in Open Rhinoplasty: A Retrospective Cohort Study

Background

Open rhinoplasty, including the transcolumellar approach, is commonly performed as it has fewer side effects and provides superior anatomical control to the surgeons compared to closed rhinoplasty. However, the postoperative scar outcomes, such as scar appearance, vary depending on the type of suture used in wound closure, and the optimal suture type is not firmly established.

Objective

To compare the impact of catgut versus polypropylene sutures on the postoperative transcolumellar scar outcomes and patient satisfaction following open rhinoplasty.

Methods

This retrospective cohort study, including 100 patients who underwent transcolumellar open rhinoplasty, was conducted at otolaryngology department of King Abdulaziz University Hospital, Riyadh, KSA. The patients were divided into two groups: the propylene suture group (group 1), which included 15 males and 35 females with a mean age of 31.5 years and underwent surgery using propylene sutures, and the catgut suture group (group 2), which included 10 males and 40 females with a mean age of 30.5 years and underwent surgery using catgut sutures. The postoperative transcolumellar scar outcomes, as determined by visual analogue scale (VAS) and Stony Brook Scar Evaluation Scale (SBSES) scores, and patient satisfaction, as assessed using a self-assessment scale, were compared between groups.

Results

The scars were unnoticeable in the majority of both groups: 88% in group 1 and 86% in group 2. The VAS and SBSES scores did not significantly differ between groups. Patients' satisfaction rates were also comparable and did not significantly differ between groups (p = 0.341).

Conclusion

Both catgut and polypropylene sutures lead to similar outcomes and patient satisfaction rates in terms of postoperative rhinoplasty transcolumellar scars. Thus, catgut may be the optimal suture for closing transcolumellar incisions following open rhinoplasty.