Research Progress of Surgical Sutures with Integrated Diagnostic and Therapeutic Functions

doi:10.19894/j.issn.1000-0518.240140

Chinese Journal of Applied Chemistry ›› 2024, Vol. 41 ›› Issue (10): 1399-1408.DOI: 10.19894/j.issn.1000-0518.240140

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Research Progress of Surgical Sutures with Integrated Diagnostic and Therapeutic Functions

Xiao-He WANG¹, Lin XU², Li FU¹()

^1.Department of Implantology，Hospital of Stomatology，Jilin University，Changchun 130021，China
^2.State Key Laboratory of Integrated Optoelectronics，College of Electronic Science and Engineering，Jilin University，Changchun 130012，China

Received:2024-04-27 Accepted:2024-08-18 Published:2024-10-01 Online:2024-10-29
Contact: Li FU
About author:fuli1127@jlu.edu.cn

Abstract

Abstract:

Chronic hard-to-heal wounds are one of the health problems affecting millions of people worldwide. Assessing the wound condition promptly and implementing effective treatments are essential for wound healing management， yet this remains a clinical challenge. Surgical suture plays an important role in the closure and healing of wound tissue. In recent years， it has become a research hotspot to modify sutures using physical and chemical methods， endowing them with monitoring and pro-healing functions. The current relevant research has made considerable progress in the materials， structural design and functionalization of sutures and intelligent modifications. This paper describes the classification and function of sutures， introduces the strategies for constructing functional diagnostic sutures and their research progress， and discusses the challenges and prospects faced by functional sutures. It aims to provide ideas and references for the design and research direction of intelligent diagnostic sutures.

Key words: Sutures, Wound healing, Wound monitoring, Infection, Tissue repair

CLC Number:

O631

Xiao-He WANG, Lin XU, Li FU. Research Progress of Surgical Sutures with Integrated Diagnostic and Therapeutic Functions[J]. Chinese Journal of Applied Chemistry, 2024, 41(10): 1399-1408.

Figures/Tables 6

Fig.1 Surgical sutures with integrated diagnostic and therapeutic functions

Table 1 Materials and types of surgical sutures

Catgut

Collagen

Cotton

Linen

Nylon

Silk

Natural

Absorbable

Non-absorbable

Monofilament

Multifilament

Monofilament

Multifilament

Polycaprolactone

Poly（p-diaxanone）

Poly（glycoloic acid）

Poly（lactic acid）

Poly（lactic-co-glycolic acid）

Polyglyconate

Polypropylene

Polyamide

Polybutester

Polyester

Polyurethane

Synthetic

Absorbable

Non-absorbable

Monofilament

Monofilament/Multifilament

Monofilament

Monofilament/Multifilament

Monofilament

Multifilament

Fig.2 （A） Self tightening behavior of PU/RCD［22］；（B）（a） Barb geometry and （b） barb digital image［28］

Fig.3 （A） Re-cultured colonies of tested bacterial strain on agar plates： a. bombyx mori silk fibroin， b. non-coated P.ricini waste suture， c. coated P.ricini waste suture［35］；（B） P.aeruginosa and S. aureus treated with unmodified and modified AgNPs of silk fibers： a. fluorescent micrographs， b. electron micrographs［39］

Fig. 4 （A）A schematic of the drug release electronic suture system with a conductive fiber strain sensor core and a thermos-responsive polymer shell containing drugs［56］?；（B） Schematic of the layered composition of BSS and illustration of the specific working relationships between the three layers of the shell to achieve its properties of wound sensing， cell growth promotion andbactericidal effects［57］

Fig.5 （A） Schematics of Cur@ZIF-8 decorated surgical sutures （SZC） with microenvironment pH-responsive release behavior and wound healing acceleration property［59］；（B） Schematic of drug release from drug-loaded sutures［62］

References 62

1	ZHANG R， TIAN Y， PANG L， et al. Wound microenvironment-responsive protein hydrogel drug-loaded system with accelerating healing and antibacterial property［J］. ACS Appl Mater Interfaces， 2022， 14（8）： 10187-10199.
2	ABBAS M， HUSSAIN T， ARSHAD M， et al. Wound healing potential of curcumin cross-linked chitosan/polyvinyl alcohol［J］. Int J Biologic Macromol， 2019， 140： 871-876.
3	VIVCHARENKO V， TRZASKOWSKA M， PRZEKORA A. Wound dressing modifications for accelerated healing of infected wounds［J］. Int J Mol Sci， 2023， 24（8）： 7193.
4	CHEN X， TAN P， WEN Y， et al. Facile scalable one-step wet-spinning of surgical sutures with shape memory function and antibacterial activity for wound healing［J］. Chin Chem Lett， 2020， 31（6）： 1499-1503.
5	ALSHOMER F， MADHAVAN A， PATHAN O， et al. Bioactive sutures： a review of advances in surgical suture functionalisation［J］. Current Med Chem， 2017， 24（2）： 215-223.
6	TANIGUCHI H， MATSUMOTO-ODA A. Wound healing in wild male baboons： estimating healing time from wound size［J］. PLoS One， 2018， 13（10）： 1-13.
7	MUYSOMS F E， ANTONIOU S A， BURY K， et al. European Hernia Society guidelines on the closure of abdominal wall incisions［J］. Hernia， 2015， 19（1）： 1-24.
8	SETIAWATI A， JANG D， CHO D， et al. An accelerated wound-healing surgical suture engineered with an extracellular matrix［J］. Adv Healthc Mater， 2021， 10（6）： 2192-2640.
9	PHAN P T， HOANG T T， THAI M T， et al. Smart surgical sutures using soft artificial muscles［J］. Sci Rep， 2021， 11（1）： 22420.
10	YANG Y， YANG S B， WANG Y G， et al. Bacterial inhibition potential of quaternised chitosan-coated VICRYL absorbable suture： an in vitro and in vivo study［J］. J Orthop Translat， 2017， 8： 49-61.
11	PARELL G J， BECKER G D. Comparison of absorbable with nonabsorbable sutures in closure of facial skin wounds［J］. Arch Facial Plastic Surgery， 2003， 5（6）： 488-490.
12	BYRNE M， ALY A. The surgical suture［J］. Aesthetic Surgery J， 2019， 39： S67-S72.
13	ABHARI R E， MARTINS J A， MORRIS H L， et al. Synthetic sutures： clinical evaluation and future developments［J］. J Biomater Appl， 2017， 32（3）： 410-421.
14	CLAUDE O， GREGORY T， MONTEMAGNO S， et al. Vascular microanastomosis in rat femoral arteries： experimental study comparing non-absorbable and absorbable sutures［J］. J Reconstruct Microsurgery， 2007， 23（2）： 87-91.
15	JOSEPH B， GEORGE A， GOPI S， et al. Polymer sutures for simultaneous wound healing and drug delivery-a review［J］. Int J Pharm， 2017， 524（1/2）： 454-466.
16	KURAHASHI E， SUGIMOTO H， NAKANISHI E， et al. Shape memory properties of polyurethane/poly（oxyethylene） blends‍［J］. Soft Matter， 2012， 8（2）： 496-503.
17	VAKIL A U， PETRYK N M， SHEPHERD E， et al. Biostable shape memory polymer foams for smart biomaterial applications［J］. Polymers， 2021， 13（23）： 4084.
18	CHATTERJEE T， DEY P， NANVO G B， et al. Thermoresponsive shape memory polymer blends based on alpha olefin and ethylene propylene diene rubber［J］. Polymer， 2015， 78： 180-192.
19	ZHOU W C， TAN P F， CHEN X H， et al. Berberine-incorporated shape memory fiber applied as a novel surgical suture［J］. Front Pharmacol， 2020， 10： 1506.
20	JOO Y S， CHA J R， GONG M S. Biodegradable shape-memory polymers using polycaprolactone and isosorbide based polyurethane blends［J］. Mater Scie Eng C-Mater Biolog Appl， 2018， 91： 426-435.
21	DUARAH R， SINGH Y P， GUPTA P， et al. High performance bio-based hyperbranched polyurethane/carbon dot-silver nanocomposite： a rapid self-expandable stent［J］. Biofabrication， 2016， 8（4）： 045013.
22	DUARAH R， SINGH Y P， GUPTA P， et al. Smart self-tightening surgical suture from a tough bio-based hyperbranched polyurethane/reduced carbon dot nanocomposite［J］. Biomed Mater， 2018， 13（4）： 045004.
23	NESPOLI A， NINARELLO D， BASSANI E， et al. Proof of concept of a self-tightening needle-less suture using a NiTi shapememory alloy［J］. Bio-Design Manufact， 2023， 6（5）： 536-549.
24	QI X， XU E， JIA M， et al. Bio-based， self-crosslinkable eucommia ulmoides gum/silica hybrids with body temperature triggering shape memory capability［J］. Macromol Mater Eng， 2021， 306（11）：2100370.
25	INGLE N P， KING M W. Optimizing the tissue anchoring performance of barbed sutures in skin and tendon tissues［J］. J Biomechanics， 2010， 43（2）： 302-309.
26	MCKENZIE A R. An experimental multiple barbed suture for the long flexor tendons of the palm and fingers. preliminary report［J］. J Bone Joint Surgery British Vol， 1967， 49（3）： 440-447.
27	BARRIE K A， TOMAK S L， CHOLEWICKI J， et al. The role of multiple strands and locking sutures on gap formation of flexor tendon repairs during cyclical loading［J］. J Hand Surgery-Am Vol， 2000， 25（4）： 714-720.
28	INGLE N P， KING M W， ZIKRY M A. Finite element analysis of barbed sutures in skin and tendon tissues［J］. J Biomech， 2010， 43（5）： 879-886.
29	HUANG Y， CADET E R， KING M W， et al. Comparison of the mechanical properties and anchoring performance of polyvinylidene fluoride and polypropylene barbed sutures for tendon repair‍［J］. J Biomed Mater Res Part B-Appl Biomater， 2022， 110（10）： 2258-2265.
30	LAROCHE G， MAROIS Y， SCHWARZ E， et al. Polyvinylidene fluoride monofilament sutures： can they be used safely for long-term anastomoses in the thoracic aorta？［J］. Artific Organs， 1995， 19（11）： 1190-1199.
31	BARBOLT T A. Chemistry and safety of triclosan， and its use as an antimicrobial coating on coated VICRYL* plus antibacterial suture （coated polyglactin 910 suture with triclosan）‍［J］. Surg Infect， 2002， 3（Suppl 1）： S45-53.
32	PAUL M D. Bidirectional barbed sutures for wound closure： evolution and applications‍［J］. J Am College Certified Wound Specialists， 2009， 1（2）： 51-57.
33	DENNIS C， SETHU S， NAYAK S， et al. Suture materials-current and emerging trends‍［J］. J Biomed Mater Res Part A， 2016， 104（6）： 1544-1559.
34	GALAL I， EL-HINDAWY K. Impact of using triclosan-antibacterial sutures on incidence of surgical site infection‍［J］. Am J Surgery， 2011， 202（2）： 133-138.
35	KALITA H， HAZARIKA A， KALITA S， et al. Antimicrobials tethering on suture surface through a hydrogel： a novel strategy to combat postoperative wound infections［J］. RSC Adv， 2017， 7（52）： 32637-32646.
36	CHEN X， ZHANG Q， HOU D， et al. Fabrication and characterization of novel antibacterial silk sutures with different braiding parameters［J］. J Nat Fibers， 2019， 16（6）： 866-876.
37	CIRALDO F E， LIVERANI L， GRITSCH L， et al. Synthesis and characterization of silver-doped mesoporous bioactive glass and its applications in conjunction with electrospinning［J］. Materials， 2018， 11（5）： 692.
38	CIRALDO F E， SCHNEPF K， GOLDMANN W H， et al. Development and characterization of bioactive glass containing composite coatings with ion releasing function for antibiotic-free antibacterial surgical sutures‍［J］. Materials， 2019， 12（3）： 423.
39	DHAS S P， ANBARASAN S， MUKHERJEE A， et al. Biobased silver nanocolloid coating on silk fibers for prevention of post-surgical wound infections［J］. Int J Nanomed， 2015， 10（Suppl 1）： 159-170.
40	ZHOU Y L， YANG Q Q， ZHANG L， et al. Nanoparticle-coated sutures providing sustained growth factor delivery to improve the healing strength of injured tendons［J］. Acta Biomater， 2021， 124： 301-314.
41	ALVAREZ-PAINO M， MUNOZ-BONILLA A， FERNANDEZ-GARCIA M. Antimicrobial polymers in the nano-world［J］. Nanomaterials， 2017， 7（2）： 48.
42	SCHULTZ G S， SIBBALD R G， FALANGA V， et al. Wound bed preparation： a systematic approach to wound management［J］. Wound Repair Regen， 2003， 11 （Suppl 1）： S1-S28.
43	JOHNSON P C， ROBERTS A D， HIRE J M， et al. The effect of instrumentation on suture tensile strength and knot pullout strength of common suture materials［J］. J Surgic Educ， 2016， 73（1）： 162-165.
44	YU N， CAI T， SUN Y， et al. A novel antibacterial agent based on AgNPs and Fe₃O₄ loaded chitin microspheres with peroxidase-like activity for synergistic antibacterial activity and wound-healing［J］. Int J Pharma， 2018， 552（1/2）： 277-287.
45	ZENG Q， HAN K， ZHENG C， et al. Degradable and self-luminescence porous silicon particles as tissue adhesive for wound closure， monitoring and accelerating wound healing［J］. J Colloid Interface Sci， 2022， 607： 1239-1252.
46	SRIDHAR R， LAKSHMINARAYANAN R， MADHAIYAN K， et al. Electrosprayed nanoparticles and electrospun nanofibers based on natural materials： applications in tissue regeneration， drug delivery and pharmaceuticals［J］. Chem Soc Rev， 2015， 44（3）： 790-814.
47	YANG Y， XIA T， ZHI W， et al. Promotion of skin regeneration in diabetic rats by electrospun core-sheath fibers loaded with basic fibroblast growth factor［J］. Biomater， 2011， 32（18）： 4243-4254.
48	TOTTOLI E M， DORATI R， GENTA I， et al. Skin wound healing process and new emerging technologies for skin wound care and regeneration［J］. Pharmaceutics， 2020， 12（8）： E735.
49	FIERHELLER M， SIBBALD R G. A clinical investigation into the relationship between increased periwound skin temperature and local wound infection in patients with chronic leg ulcers［J］. Adv Skin Wound Care， 2010， 23（8）： 369-379.
50	NAKAGAMI G， SANADA H， IIZAKA S， et al. Predicting delayed pressure ulcer healing using thermography： a prospective cohort study［J］. J Wound Care， 2010， 19（11）： 465-472.
51	KIM D H， WANG S， KEUM H， et al. Thin， flexible sensors and actuators as 'instrumented' surgical sutures for targeted wound monitoring and therapy ［J］. Small， 2012， 8（21）： 3263-3268.
52	WIJLENS A M， HOLLOWAY S， BUS S A， et al. An explorative study on the validity of various definitions of a 2.2 ℃ temperature threshold as warning signal for impending diabetic foot ulceration［J］. Int Wound J， 2017， 14（6）： 1346-1351.
53	HOUSHYAR S， BHATTACHARYYA A， KHALID A， et al. Multifunctional sutures with temperature sensing and infection contro［J］. Macromol Biosci， 2021， 21（3）： e2000364.
54	GAO B， GUO M， LYU K， et al. Intelligent silk fibroin based microneedle dressing （i-SMD）［J］. Adv Funct Mater， 2021， 31（3）： 1-9.
55	GUO M， WANG Y， GAO B， et al. Shark tooth-inspired microneedle dressing for intelligent wound management［J］. ACS Nano， 2021， 15（9）： 15316-15327.
56	LEE Y， KIM H， KIM Y， et al. A multifunctional electronic suture for continuous strain monitoring and on-demand drug release［J］. Nanoscale， 2021， 13（43）： 18112-18124.
57	LIU M， ZHANG Y， LIU K， et al. Biomimicking antibacterial opto-electro sensing sutures made of regenerated silk proteins［J］. Adv Mater， 2021， 33（1）： e2004733.
58	PERCIVAL S L， FINNEGAN S， DONELLI G， et al. Antiseptics for treating infected wounds： efficacy on biofilms and effect of pH［J］. Critical Rev Microbiol， 2016， 42（2）： 293-309.
59	ZHANG Q， ZOU Y， TANG L， et al. Stage-controlled antibacterial surgical sutures based on curcumin@ZIF-8 functional coating for improved wound healing［J］. Prog Org Coat， 2023， 184： 107829.
60	MORELLI F， ANDERSON A， MCLISTER A， et al. Electrochemically driven reagent release from an electronic suture‍［J］. Electrochem Commun， 2017， 81： 70-73.
61	HANAFI A， NOGRALES N， ABDULLAH S， et al. Cellulose acetate phthalate microencapsulation and delivery of plasmid DNA to the intestines［J］. J Pharma Sci， 2013， 102（2）： 617-626.
62	CABOT J M， DAIKUARA L Y， YUE Z， et al. Electrofluidic control of bioactive molecule delivery into soft tissue models based on gelatin methacryloyl hydrogels using threads and surgical sutures［J］. Sci Rep， 2020， 10（1）： 1-10.

Research Progress of Surgical Sutures with Integrated Diagnostic and Therapeutic Functions

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