Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials

Objective:The objective of this article is to systematically analyse the randomized,controlled trials that compare the use of antibacterial sutures(ABS)for skin closure in controlling surgical site infections.Methods:Randomized,controlled trials on surgical patients comparing the use of ABS for skin closure in controlling the surgical site infections were analysed systematically using RevMan^(■)and combined outcomes were expressed as odds ratios(OR)and standardized mean differences(SMD).Results:Seven randomized,controlled trials evaluating 1631 patients were retrieved from electronic databases.There were 760 patients in the ABS group and 871 patients in the simple suture group.There was moderate heterogeneity among trials(Tau^(2)=0.12;chi^(2)=8.40,df=6[P<0.01];I^(2)=29%).Therefore in the random-effects model,the use of ABS for skin closure in surgical patients was associated with a reduced risk of developing surgical site infections(OR,0.16;95%CI,0.37,0.99;z=2.02;P<0.04)and postoperative complications(OR,0.56;95%CI,0.32,0.98 z=2.04;P=0.04).The durations of operation and lengths of hospital stay were similar following the use of ABS and SS for skin closure in patients undergoing various surgical procedures.Conclusion:Use of ABS for skin closure in surgical patients is effective in reducing the risk of surgical site infection and postoperative complications.ABS is comparable with SS in terms of length of hospital stay and duration of operation.

Antibacterial Sutures Coated with Smooth Chitosan Layer by Gradient Deposition

Owing to the significant importance in clinics,antibacterial activity is thought as one indispensable feature of the next generation of absorbable sutures.It is challenging but imperative to arm the existing absorbable sutures with antibacterial functions.The present study describes a“gradient deposition”technique to coat a continuous and smooth layer of chitosan on the surface of absorbable sutures.Specifically,chitosan solution is arranged to undergo gradient pH decline step by step while during each pH interval,the solution is allowed to stand for a predetermined period of time in order to control gradual chitosan deposition.Chitosan nanoparticles are found to be first generated on suture surface and finally developed into a smooth chitosan layer as the antibacterial surface.In vitro and in vivo results demonstrated that coating chitosan on sutures by our technique could relieve wound inflammation,stimulate collagen deposition,regenerate blood vessels,and assist tissue repairing,consequently leading to a significant enhancement of wound healing effect.This technique is highlighted with low cost,extreme convenience and excellent safety without organic solvents.Furthermore,the“gradient deposition”technique would not affect the fundamental properties of matrix and thus hold promises as a universal way for superficial antibacterial modification towards almost all the surgical implanted materials,including but not limited to absorbable sutures.