TABLE 3.
Surgical sutures in wound management
| Polymers | Absorbability | Bioactive molecules | Process technique | Duration of release/degradation | Type of analysis done | Properties/results | References |
|---|---|---|---|---|---|---|---|
| PCL/collagen | Absorbable | bFGF | Electrospinning | Over 21 days (bFGF release) | Morphology analysis, mechanical testing, growth factor release and in vivo study. | bFGF loading rate reached 33.3%, and PCL/collagen nanofibers were highly aligned, which offered a high surface area to improve mechanical strength. | [102] |
| PDO | Non‐absorbable | Fibronectin | Dip‐coating | 24 h (fibronectin release) | Physicochemical testing, fibronectin release, in vitro cell culture and in vivo study. | Fibronectin‐coated suture reduced tissue drag, improved wound healing, and limited scar formation through enhanced re‐epithelialization. | [261] |
| DAC | Absorbable | — | Wet spinning | 42 days (suture degradation) | Physicochemical testing, mechanical testing and in vivo study. | DAC suture had tensile strength for conventional suturing and significantly reduced wound healing time on a full‐thickness wound model. | [273] |
| PLGA | — | mRNA | Dip‐coating | — | Physicochemical testing, mechanical testing, real‐time Quantitative PCR (qPCR,) in vitro cell culture and hemocompatibility testing. | mRNA‐PLGA coated suture did not affect cell viability and stimulated keratinocyte growth factor and functional fluorescent protein expression, which accelerated the wound healing process. | [274] |
| Nylon (braided) | Non‐absorbable | Rifampicin/ trans‐resveratrol | Coating | 5 weeks (drug release) | Morphology analysis, mechanical testing, in vitro drug release, antimicrobial, and anti‐inflammatory testing. | Drug coated sutures achieved drug release within 5 weeks and demonstrated excellent antimicrobial and anti‐inflammatory properties. | [262] |
| PCL (twisted) | Absorbable | Gentamicin/Ag | Electrospinning | Over 5 weeks (drug/silver release) | Morphology analysis, mechanical testing, in vitro drug/silver release, in vitro cell culture and antimicrobial testing | Drug/Ag‐coated PCL sutures had sustained release over 5 weeks after an initial burst and exhibited no influence on skin cell migration. Sutures inhibited bacterial growth rather than silver or drug alone loaded sutures. | [275] |
| AASF | Non‐absorbable | AMOX | Soaking | 336 h (AMOX release) | In vitro drug release, antibacterial test, haemolysis assay, in vivo animal model | O2 plasma‐treated AASF sutures had an increase in drug loading to 16.7% and showed bacterial inhibition to S aureus and E coli. Sustained AMOX release was observed within 336 hours after a 24 h burst release. The addition of O2 plasma treatment and AMOX did not affect the hemocompatibility of AASF suture but reduced wound healing time. | [276] |
| PP | Absorbable | Ag particles (3–5 wt%) | Grafting | — | Physicochemical testing, Morphology analysis, mechanical testing, antimicrobial test, cytocompatibility test | Radiation‐grafted and Ag‐loaded PP sutures demonstrated antimicrobial activity without adverse effects on cell viability. | [277] |
| Fibrin | Absorbable | hMSCs |
Solution coextrusion |
1 week (hMSCs delivery) | hMSC attachment quantification, In vivo animal model. | Fibrin biological sutures were developed to deliver cells to infarcted tissue. 100,000 cells per suture seeded for 12–24 h. The authors were not confident in using hMSCs for regenerating contractile cardiomyocytes. |
[278] |
| PP, PET, PDO, glycolic acid. | Non‐absorbable/ absorbable | Oxygen plasma | Coating | 60–90 days (suture degradation) | Morphology analysis, antimicrobial testing, tissue drag testing, mechanical testing, in vitro degradation, in vivo animal model. | Nanostructures were generated on the surface of commercial sutures via oxygen plasma treatment, which inhibited biofilm formation. | [279] |
| PCL | Absorbable | Tadalafil | Electrospinning | 15 days (tadalafil release) | Morphology analysis, mechanical testing, in vitro drug release, in vivo animal model | Tadalafil loaded PCL suture demonstrated a sustained release, with no toxic effect on the systemic circulation. The number of blood vessels, fibroblast and epithelization significantly improved, which in turn enhanced the wound healing process. | [280] |
| Polyglactin 910 | Absorbable | PDGF‐BB | Dip‐coating | 48 h (PDGF‐BB delivery) | In vitro PDGF‐BB release, in vivo animal model, in vivo uniaxial tensile biomechanical analysis |
PDGF‐BB coated commercial Vicryl sutures enhanced the remodeling phase in a rat model at 4 weeks following surgery. |
[281] |
| Polyglactin 910 | Absorbable | BMSC | Coating | — | In vivo animal model | BMSC coated commercial Vicryl sutures with stem cells attached to the surface, became unattached and migrated into the wound site to support soft tissue regeneration. | [282] |
| Polyglactin 910/PLGA/PEG | Absorbable | Diclofenac sodium salt | Dip‐coating | 7 days (diclofenac release) | Physicochemical testing, Morphology analysis, in vitro drug release, in vitro cell culture, In vivo evaluation of anti‐inflammatory effects. | Diclofenac loaded PLGA nanoparticles with PEG and coated them onto commercial Vicryl suture surface. Diclofenac was released sustainably and significantly reduced the inflammatory reactions of tissues around the suture in the rat. | [283] |
| PLLA (core)/PLGA (shell) | Absorbable | Aceclofenac (15%)/ insulin (4%) | Electrospinning |
10 days (aceclofenac release), 7 days (insulin release). 4 weeks (sheath degradation), 1 year (core degradation). |
Morphological analysis, Mechanical testing, in vitro degradation study, in vitro drug release, in vitro cell culture, in vivo animal model. | Aceclofenac loaded PLLA/PLGA core‐shell structural sutures were released within 10 days and reduced inflammation reactions in the animal model. Insulin loaded PLLA/PLGA core‐shell structural sutures were released within 7 days and accelerated the wound healing process. | [284] |
| Polyglactin 910 | Absorbable | Silver | Soaking | 21 days (silver release & suture degradation) | Physicochemical testing, Morphology analysis, in vitro degradation, in vitro silver release, antimicrobial test, in vitro cell culture, MTT assay, live/dead assay, scratch assay. | Silver coated polyglactin 910 sutures exhibited antibacterial activities and promoted cell migration and proliferation, which indicates its potential for facilitating wound healing. | [285] |
| Fibrin | Absorbable | hMSCs | Solution coextrusion |
1–2 weeks (suture degradation) |
In vitro live/dead cell viability assay, in vivo animal model, in vivo global mechanical function, in vivo cell delivery. | hMSCs incorporated fibrin biological sutures reduced fibrosis and enhanced mechanical properties. | [286] |
| PCL (core)/PEG–PLA (sheath) | Absorbable | Curcumin | Electrospinning | 160 h (curcumin release) | Morphological analysis, mechanical testing, in vitro curcumin release. | Core‐sheath structured sutures had more drug release when the fibers had finer cores. The drug release time frame was controlled by adjusting the parameters of the electrospun process. | [287] |
Abbreviations: AASF, Antheraea assama silk fibroin; Ag, silver; AMOX, amoxicillin trihydrate; BMSC, bone‐marrow‐derived mesenchymal stem cells; DAC, diacetyl chitin; hMSCs, human mesenchymal stem cells; mRNA, messenger ribonucleic acid; PCL, polycaprolactone; PDGF‐BB, platelet‐derived growth factor‐BB; PDO, polydioxanone; PEG, Polyethylene glycol; PET, poly(ethylene terephthalate); PLGA, poly(lactide‐co‐glycolide acid); PLLA, poly‐L‐lactic acid; PP, polypropylene.