Effect of hyaluronic acid added to suture material and its relationship with bacterial colonization: An in vitro study

Abstract

Aims and Objectives:The aims of this study were to evaluate the presence of Staphylococcus aureus and Escherichia coli, in polyglycolic acid (PGA) 4-0 and silk sutures, with or without hyaluronic acid (HA) treatment.Materials and Methods:This in vitro study measured S. aureus and E. coli growth on PGA and silk sutures, through incubation in agar media for 24 h. The suture length was 10 cm and divided into three parts: A (8 h), B (16 h), and C (24 h), which were observed every 8 h, followed by suspension on a microscopic slide. This was repeated thrice. The number of S. aureus and E. coli cells was recorded and compared between the suture types.Results:The mean S. aureus colony forming units (CFUs) differed at each time point between non-HA and HA-PGA sutures (P = 0.0016), with a greater number of CFUs on non-HA-PGA. The mean S. aureus CFUs were significantly higher on non-HA silk than on HA-silk sutures (P = 0.008). There was a significant increase in E. coli CFUs on non-HA silk than on HA-silk sutures (P = 0.008). E. coli CFUs were higher on non-HA-PGA than on HA-PGA sutures (P = 0.006). We performed repeated measures two-way ANOVA (SPSS version 13.0) for comparison between group factors and time points and Posthoc analysis using independent samples t-test.Conclusions:HA reduced wicking in both PGA and silk sutures.

Characteristics of Suture Materials Used in Oral Surgery: Systematic Review

“… Small sample size (10 patients only). Syafilda et al 2019 16 To compare post-odontectomy wound healing time using silk and catgut sutures NRCT Third molar impaction surgery SS Catgut 7 days On day 1 and day 7 of the surgery, the catgut sutures have a mean score of wound healing time that is better than silk sutures. However, the time needed to perform suture of cat gut is longer.…”

“…Nylon (polyamide) sutures had equal amounts of aerobes and anaerobes showing CFUs (≈300 sutures × 104/suture). Correspondingly, the effectiveness of hyaluronic acid (HA) at reducing bacterial accumulation in silk and PGA sutures (PGA) was examined in vitro by Sudhair et al, 16 and results showed that the mean S aureus and E coli CFUs were significantly higher on non-HA-treated silk than on HA-treated silk sutures. E coli CFUs were significantly higher on non-HA-treated PGA sutures than on HA-treated PGA sutures.…”

“…Thus, HA reduced bacterial accumulation in both PGA and silk sutures. 16 Asher et al concluded that neither the type of surgery (implant vs periodontal surgery) nor antibiotic taking significantly influence bacterial accumulation. However, nylon sutures showed significantly lower CFU levels compared to silk, coated polyglactin, and polyester sutures.…”

“… 11 Although multifilaments are simple to handle, they harbour more bacteria than monofilaments; multifilament sutures may be treated with HA due to the anti-inflammatory, anti-edematous, and anti-bacterial properties. 16 Every suture serves as a point of entry for an infection that might impede the wound's healing. Due to the greater surface area on which microorganisms can adhere, multifilament sutures have a higher bacterial adhesion index than monofilament sutures.…”

“…A study of Sudhair et al found that silk is known to cause inflammation due to its structure that acts as a great bacterial receptor; however, PGA had a more restricted inflammatory reaction. 16 The clinical parameters included in the study by Lekens et al 14 were the variation in the slack of the suture loop and “bite” of the suture in the tissue, which were significant variables in the assessment of immobilisation and healing of the wound margins. Slack of suture is assessed by manual probing from the top of the interdental papilla to the suture level.…”