Vicryl plus

Implant surgeries were performed by an experienced dentist (Xinhua Gu). A mini-flap approach was performed after local anesthesia (Primacaine Adrenaline; Pierre Rolland). Surgical templates were carefully fitted intraorally and stabilized with several fixation pins. Drilling of each implant site was accurately guided, 4 to 6 implants (Ankylos, Dentsply Sirona/ Straumann SLA, Institute Straumann AG/ Nobel Bioactive, Nobel Biocare) were immediately inserted in each jaw and a minimum insertion torque of 35 Ncm was obtained following the recommended protocol to obtain primary stability. Straight or angulated temporary abutments were screwed on top of the implants based on the preoperative digital design. The flap was repositioned and sutured (VICRYL Plus, Ethicon). CBCT was taken to evaluate the positions of the implants and abutments.

The clinical study was approved by the Ethics Committee (Approve number: L2021100). The patients were treated with arthroscopic ACLR. The inclusion criteria of the recruited patients were (i) they should have suffered from acute trauma within the previous 6 weeks, (ii) should have had symptoms of knee instability and other clinical evidence of ACL insufficiency verified by positive Lachman tests, (iii) MRI scans should reveal no other ligament injury except for ACL rupture, with or without accompanied meniscus injury, (iv) patients should be in good health, (v) patients should not have undergone previous ipsilateral knee joint surgery, and (vi) patients should not have been treated with medications known to affect bone metabolism. During ACLR, the time for the graft preparation of 20 HTs using the needleless grasping and the needle stitching technique (Whipstitch) (9 ) was recorded using a digital chronometer. A braided absorbable suture with a needle was used for graft suturing, with the thread material consisting of copolymer (polyglactin-910) of glycolide and lactide (1–0 VICRYL PLUS®, Ethicon, Somerville, NJ, USA). The grafts were sutured using two techniques starting at 20 mm from the distal free end of the grafts.

Animals assigned to group 1 (n = 91) were castrated using the previously described spermatic cord ligation technique and underwent surgical procedures comparable to those currently described in the scientific literature [9 ] (with the exception of the decubitus position: dorsal instead of lateral). Castration was performed by placing a ligature around the vascular portion of the spermatic cord and the vas deferens using absorbable polyglactin 910 sutures. The suture USP size used was determined according to the respective weight of each boar, with USP 2 (Vicryl Plus, Ethicon Inc., Lamonea Medical Products, Ancona (AN), Italy) being used for animals over 100 kg, USP 1 for animals between 50 and 100 kg, and USP 0 for animals under 50 kg. The ligature was placed proximally to the spermatic cord; the spermatic cord was then transected distally of the ligatures and was inspected for the presence of hemorrhage before being placed back into the tunica vaginalis. Finally, coagulated blood particles were removed from the scrotal pouch, and the surgeon proceeded to castrate the contralateral testis using the same technique described above.

The macrosurgical task was chosen to resemble suturing of dura mater. It was always performed prior to the microsurgical task. The task was to re-attach a circular piece (diameter 50 mm) cut from a latex surgical glow (Abena®, Aabenraa, Denmark) wrapped around a 1000-ml standard IV-infusion bag (Natriumklorid Baxter Viaflo®, Baxter, Deerfield, Illinois, USA) (Fig. 1). The re-attachment was performed with eight single interrupted 4–0 multifilament sutures (Vicryl Plus®, Ethicon, Johnson & Johnson, New Brunswick, New Jersey, USA). The duration from the first stitch to cutting the threads of the last stitch was measured. The quality of the sutures of each task was ranked between zero to three points according to Fig. 2. All the evaluations were done by a single author (C.E.). One point was lost if there were more than 2:1 deviations in the following parameters: (i) the length of the suture ends within all sutures (later referred as deviation of suture ends), (ii) the distance between any of the adjacent sutures (later referred as unequal distancing), (iii) the entry of suture in the opposite borders of simulated wound (later referred as deviation of suture entry).Fig. 1

a and b The models used for macro- (a) and microsurgical (b) tasks

Fig. 2

The instructions for calculation of quality points for each surgical task

In this study, uncoated braided absorbable—polyglycolic acid—suture Gunze (G: Gunze PGA, Kyoto, Japan) of 0.4 mm in diameter, corresponding to the United States Pharmacopeia standard USP1, was used to produce antimicrobial sutures by coating. Suture controls were commercial PGA Resorba® (R: Resorba, Nürnberg, Germany), Vicryl® and triclosan-containing Vicryl® Plus (V and VP, respectively: Ethicon, Norderstedt, Germany). Furthermore, Gunze PGA sutures only coated with fatty acids—palmitic acid (PA80) and lauric acid (LA80)—were tested to investigate potential effects of drug carriers only.

A laparoscopic 0° camera with three-dimensional visualization (Karl Storz, Tuttlingen, Germany) was used with an 11-mm disposable trocar at the umbilicus and two 5-mm disposable trocars for instruments on both sides of the umbilicus (trocars from Ethicon, Johnson & Johnson, Somerville, NJ, USA). Pneumoperitoneum was created with a Veress needle, with pressure maintained at 12 mmHg. Self-gripping monofilament polyester mesh (Parietex Progrip™ Self-Fixating Mesh; Medtronic, Minneapolis, MN, USA) was used, with a width of 16 cm and length of 12 cm for unilateral hernias, and a width of 28 cm and length of 13 cm for bilateral hernias. Care was taken to close the peritoneum properly after mesh placement using a barbed suture (V-Loc™ 90; Medtronic). The fascia at the umbilical trocar site was closed with a U stitch of absorbable suture, size 0 (Vicryl^® Plus; Ethicon, Johnson & Johnson). Two semireusable endograspers were used, in addition to disposable endoscopic scissors with monopolar cautery, and a reusable needle-driver.

In all 22 patients, the abdominal fascia was closed with interrupted suture using 0-coated polyglactin 910 with triclosan (VICRYL PLUS™, Ethicon, Johnson & Johnson, Somerville, NJ, USA) and/or running suture using 0-polydioxanone (PDS II™, Ethicon, Johnson & Johnson), with the wound left open. The subcutaneous defect of the wound was filled with polyurethane foam, and negative pressure (−80 mmHg) was applied with a RENASYS™ negative-pressure wound therapy system (Smith & Nephew, Watford, UK). A single surgeon (YS) changed the dressing and examined the status of each wound routinely on postoperative days (POD) 3 and 7.
Wound closure was defined based on the observation of healthy granulation tissue on the exposed fascia with no clinical signs of infection on POD 7. Delayed suture using 3-0 nylon monofilament (Keisei Medical Industrial, Tokyo) or wound taping was performed as appropriate. NPWT was continued another 4 days if the granulation on the exposed fascia was not sufficient. All patients received scheduled follow-up within 30 days after surgery.