Antibacterial Polyglactin 910
Antibacterial polyglactin 910 are polyfilament braided absorbable sutures coated with antibacterial agents (triclosan / chlorhexidine) to prevent surgical site infections.
Example – Coated Vicryl Plus, Mitsu C+ suture
A. Antibacterial polyglactin 910 – with triclosan (eg. Coated vicryl plus)
Composition
Antibacterial polyglactin (eg. Coated Vicryl plus) is composed of copolymer from 90% glycolide and 10% L-lactide and coated with mixtures of equal parts of glycolide + lactide and calcium stearate. It is further coated with triclosan (not more than 472µg/m) which is a broad spectrum antibacterial agent.
Characteristics
It is also non-antigenic, non-pyrogenic in nature, elicits a mild tissue reaction but it is slightly oversize in diameter than requirements established by the United States Pharmacopoeia (USP). This may require additional throws along with recommended flat and square knot ties.
Advantages
It inhibits colonization of bacterial species like Staphylococcus aureus, MRSA (Methicillin Resistant Staphylococcus aureus), Staphylococcus epidermidis which are potential cause of surgical site infection.
Fig: Coated Vicryl Plus by Ethicon
Absorption
Absorption occurs through hydrolysis process and degraded to glycolic acid and lactic acids. Suture tensile strength is reduced by 25% in one week and 50% in three weeks. Complete absorption takes 8-10 weeks.
Indications
It is indicated in general soft tissue approximation or ligation but not suitable for ophthalmic, neurological and cardiovascular procedures.
Contraindications
Antibacterial polyglactin 910 sutures should not be used in the parts where extended approximation is required or patients having any known sensitivity to contents of suture material i.e. glycolide, lactide, calcium stearate or triclosan.
Tissue reaction
It may induce foreign body response like other sutures and use in biliary and urinary tract surgical procedures may lead into calculus formation at the site.
Storage and Handling
Re-sterilization of unused sutures is not recommended. It should be stored below 25°C in dry conditions.
B. Antibacterial polyglactin 910 – with chlorhexidine (eg. Mitsu C+ suture)
Composition
It is made up of copolymer glycolide-co-l-lactide in the ration of 90/10 respectively and coated with chlorhexidine an antibacterial agent.
Characteristics
It is a mid-term absorbable, multifilament braided suture with gentle knot repositioning, smooth knot run down/knot slide, excellent knot security and minimal inflammatory reaction.
Tensile strength
Knot retention and tensile strength is similar to the plain polyglactin and retains 75% knot tensile strength upto 14 days and complete absorption takes place within 56 to 70 days.
Fig: Mitsu C+ Polyglactin 910
Absorption
It is degraded by the hydrolysis into glycolic acid and lactic acids which are metabolized in the body.
Coating with chlorhexidine minimizes the risk of suture induced surgical site infection.
Indications
It is used for general soft tissue surgeries, approximation / ligations and indications of normal polyglactin 910 sutures can be followed.
Contraindications
Use should be avoided in case of known hyper sensitivity to any of its components. General guidelines for suture handling should be followed.
FAQs
Triclosan is an antimicrobial substance. It is used to coat absorbable sutures and these sutures are called triclosan sutures or triclosan coated suture e.g. Vicryl Plus, PDS Plus. They help in reducing surgical site infections.
Triclosan has broad spectrum antimicrobial activity and have to be proven effective against many gram-positive and gram-negative bacteria. It is also effective against methicillin resistant bacteria. It inhibits bacterial amino acid synthesis.