Bioactive Sutures: A Review of Advances in Surgical Suture Functionalisation

Abstract

Sutures have been at the forefront of surgical medicine throughout time. With recent advances in suture technology, it is possible to incorporate biologically active substances to enhance suture function and capability. Bioactive sutures represent a modality interest in controlled drug and cell delivery to traumatic sites. In this article, a comprehensive literature search of key bibliographic databases focusing on suture material fabrication and advanced modification was performed. The history, manufacturing process and cost-effectiveness of bioactive sutures are presented. Several novel modifications to enhance function in drug and growth factor delivery and cell therapy are also reviewed. Different antimicrobial drugs and anaesthetics have been shown to be effective in reducing inflammation and bacterial infection. Cellular therapy represents a unique modality augmenting the surgical repair of various soft tissue injuries. We propose a definition of bio-active sutures as biomaterials that are engineered to have controlled tissue interaction to optimise wound/defect healing, in addition to their essential function in tissue approximation.

Development and Characterization of Bioactive Glass Containing Composite Coatings with Ion Releasing Function for Antibiotic-Free Antibacterial Surgical Sutures

“…Due to their widespread application in medicine, e.g., routine skin laceration or organ transplantation [1,2], sutures are one of the largest groups of medical devices implanted in humans (250 million per year only in the USA) [3]. Sutures can be produced using natural or synthetic materials and can be resorbable or non-resorbable [4]. Prominent synthetic bio-resorbable materials used for sutures are polyglycolic acid (PGA), polylactic acid (PLA), or polyglycolide lactide copolymers (PLGA).…”

Electrochemically driven reagent release from an electronic suture

“…Sutures are an invaluable tool in the treatment of major wounds where they offer a speedy method of binding apposing tissues and, in principle, can facilitate wound healing [1][2][3][4]. While the general mechanism of wound closure has changed relatively little in recent years, the materials employed in the manufacture of sutures have evolved considerably.…”

“…While the general mechanism of wound closure has changed relatively little in recent years, the materials employed in the manufacture of sutures have evolved considerably. Biodegradability, physical structure and chemical composition are the key factors subject to manipulation and there is a wealth of commercially available variants [2,3]. Sutures possessing antimicrobial activity are now commonplace and have arisen partly in response to the long standing issues of surgical site infection (SSI) [3].…”

“…The latter are generally acknowledged as being the most commonly incurred postoperative complication and are attributed to 15-20% of all nosocomial infection arising after surgery [5,6]. It has been demonstrated that sutures loaded with antimicrobial agents (such as triclosan or silver nanoparticles) reduce infection rates and improve wound recovery [2,3,[6][7][8][9][10]. Irrespective of design, commercial sutures are typically based on a thread-like form to provide the mechanical resilience needed to draw the wound edges together and, thereafter, the antimicrobial features are invariably delivered through passive interaction with the surrounding tissue [2].…”

“…It has been demonstrated that sutures loaded with antimicrobial agents (such as triclosan or silver nanoparticles) reduce infection rates and improve wound recovery [2,3,[6][7][8][9][10]. Irrespective of design, commercial sutures are typically based on a thread-like form to provide the mechanical resilience needed to draw the wound edges together and, thereafter, the antimicrobial features are invariably delivered through passive interaction with the surrounding tissue [2]. Given the increasing concerns over antimicrobial resistance, there is a need for a further improvements in suture design where the latter is capable of providing a more active role -either through providing diagnostic telemetry of the healing dynamics or enabling the targeted delivery of drugs to the site of infection.…”