Plastic Surgery Research Council
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Presenter: Tatiana Boyko, MD
Co-Authors: Hernandez KA; Moody PW; van Harten MC; Reiffel AJ; van Koot JF; Chu CC; Harper A; Spector JA
Weill Cornell Medical College

Introduction: Despite their ubiquitous use, surgical sutures are foreign bodies which induce a local immune reaction within the adjacent tissues. This inflammatory reaction predisposes the patient to infection and leads to complications including the development of suture granulomas, tunneling, spitting and abscess formation. We introduce a novel biocompatible and biodegradable (poly (ester-amide) 8-Phe-4 polymer (PEA)) material with anti-inflammatory properties that can be used to coat sutures. We hypothesized that two widely used sutures, plain-gut and silk, would elicit a reduced inflammatory response after being coated with PEA when compared to non-coated controls.

Methods: 3-0 plain-gut and silk sutures were implanted into the gluteal muscles of C57BL/6 mice. A control non-coated suture was implanted in the left gluteus muscle while the PEA coated suture was implanted in the right. Mice were sacrificed at 3, 7, 14, and 28 days. The bilateral muscles were excised and processed for histology at each time point. The cross sectional area of inflammation surrounding the sutures was quantified using a previously described method by Sewel et al and compared using statistical analysis.

Results: Decreased inflammation (cellular infiltrate) surrounding PEA coated sutures was noted at every time point. Statistically significant reduction in the area of inflammation was seen at 28 days in plain-gut sutures (p=0.046). Statistically significant decreased inflammation was also seen at 14 days with PEA coated plain-gut suture (p= 0.0005) and at 7 days with PEA coated Silk suture (p= 0.00004).

Conclusions: PEA coating significantly reduces the local immune response to typically inflammatory silk and plain-gut sutures. These results suggest that clinical application of the PEA coating to sutures might result in a decrease of the negative sequelae associated with the foreign body response induced by sutures. Although testing with longer time points is necessary before clinical application, coating suture with PEA is a promising means of increasing the biocompatibility of commonly used sutures.

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