Suture With Resorbable Cones: Histology and Physico-Mechanical Features

Abstract

Background: Silhouette Sutures (Kolster Methods, Inc., Corona, CA) exhibit different biological characteristics at various time points after their placement.

Objectives: The goals of this study were to understand the biological reactions of Silhouette Sutures in human tissues at different time intervals and to determine the index of resistance of the sutures in subcutaneous tissue.

Methods: Histologic examination was performed on section soft tissue containing the sutures at 1 month, 3 months, 6 months, and 1 year after suture placement. The study comprised 8 patients, each of whom received 4 sutures in the lower abdomen under local anesthesia. The sutures were placed exactly 1 month, 3 months, 6 months, and 1 year before planned post-bariatric abdominal surgery. Dynamometric evaluation was performed on a never-used suture and on sutures removed from 1 year after placement. The scar process around the threads was also examined.

Results: A progressive increase in scar tissue around the sutures was observed. One year after placement, there was a reduction of 16.7% in yield and tensile strength and a reduction of 14.29% in elongation at break, relative to the never-used suture. By 1 year, the cones in polylactic and glycolic acids had been replaced by scar tissue.

Conclusions: Fibrous tissue around the sutures increased progressively over time, and was most prominent at the level of the nodes. Cones were completely resorbed within 6 months. A reduction in the index of resistance of the suspension sutures occurred over 1 year.

Figure 1.

(A) Preoperative and (B) 6 month postoperative views of a 45-year-old woman who underwent surgery in March 2012 with Silhouette Sutures in the middle third of the face.

Figure 2.

The bioabsorbable cones contained 82% L-lactic acid and 18% glycolide.

Figure 3.

Polypropylene suspension thread surrounded by scar tissue.

Figure 4.

Four 3-0 polypropylene sutures, each measuring 14.7 inches in length, were placed in the subcutaneous tissue of the abdomen (approximately 2.17 inches from the navel). To maintain the sutures under tension, each thread was fixed to the subcutaneous tissue with 4-0 Vicryl sutures. (a) 4-0 Vicryl sutures. (b) L-lactic acid and glycolide.

Figure 5.

Histologic examination at 1 month demonstrated small chronic inflammatory tissue containing histiocytes, lymphocytes, and multinucleate giant cells (25× Hematoxylin & Eosin stain).

Figure 6.

After 3 months there is an increased of the fibrous tissue and of the inflammatory component around the knot and the cone ( 10 × Hematoxylin & Eosin stain).

Figure 7.

By 6 months, the cone had deteriorated completely, and scar tissue was observed in and around the knot (a) (25× Hematoxylin & Eosin stain).

Figure 8.

By 1 year, scar tissue had formed around the polypropylene suture and the knot (a) (10× Hematoxylin & Eosin stain).

Figure 9.

Comparison of the deposition of scar tissue around the knot after 1 month (left image) and after 1 year (right image). Scar tissue was observed around the knot (a) (10× Hematoxylin & Eosin stain).