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. 2019 Apr-Jun;12(2):145-148.
doi: 10.4103/JCAS.JCAS_150_18.

In Vitro Degradation of Polydioxanone Lifting Threads in Hyaluronic Acid

Dubraska V Suárez-Vega  1 , Gladys J Velazco de Maldonado  2 , Reynaldo L Ortíz  3 , Víctor J García-Guevara  4 , Blanca Miller-Kobisher  5
Affiliations

In Vitro Degradation of Polydioxanone Lifting Threads in Hyaluronic Acid

Dubraska V Suárez-Vega et al. J Cutan Aesthet Surg. 2019 Apr-Jun.

Abstract

Recently, some clinicians have proposed implanting polydioxanone (PDO) threads imbibed in hyaluronic acid (HA), arguing that this may reinforce the lifting effects. However, this is controversial because PDO sutures are hydrophilic and the presence of HA could increase the rate of hydrolysis. The aim of this study was to demonstrate the degradation of PDO lifting threads in HA through ultramicroscopy. It was a qualitative research and preclinical trial. Three, 1-cm-long, segments of 23-G PDO threads were immersed in 1.5-mL non-crosslinked HA in previously labeled, sterile microcentrifuge tubes. These were observed by ultramicroscopy at 4× and 10× after 24, 48, and 72 h. Microphotographs taken after 24 h show structural changes in the fibers, presenting an increase in interlaminar spaces and dilution of violet pigmentation. At 48 h, degradation continues. PDO hygroscopy is observed as aqueous content between the peripheral layers and the central core of the thread. At 72 h, as the pigment is released, larger empty spaces are observed in the central column of the thread, and there is disorganization of the peripheral fibrils with fraying all along the fiber. HA induces rapid biodegradation of the PDO thread by hydrolysis beginning 24 h after contact of the thread with the biomaterial. The non-crosslinked HA is a powerful catalyzing agent for hydrolytic degradation of the PDO thread, because this thread is highly hydrophilic. Clinically, embedding PDO threads in HA accelerates biodegradation of the suture.

Keywords: Biodegradation; PDO hydrolysis; hyaluronic acid; lifting threads; polydioxanone.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Polydioxanone (PDO) thread after 24 h of immersion in HA. (A) Reflected light microphotography of the thread at 10×, which shows the widened interlaminar and interfibrillar spaces in the central column of the thread as vertical, parallel whitish bands corresponding to the dissolution of the amorphous phase of the polymer. (B) Reflected light microphotograph of the thread at 4×, which shows traces of pigment being expelled toward the periphery of the thread on a central background of interlaminar and interfibrillar empty spaces corresponding to zones of fiber hydrolysis
Figure 2
Figure 2
Polydioxanone (PDO) thread after 48 h of immersion in HA. (A) Microphotography of the thread at 4×. Note the central column of the thread showing a clear background surrounded by parallel layers in dark and light up to the periphery of the thread. (B) Area at 10×. Note the increase in bright interfibrillar spaces seen as vertical parallel whitish bands corresponding to the dissolution of the periphery of the thread. (C and D) The thread at 4×. Retention of aqueous content is observed between the peripheral layers and the central core of the thread
Figure 3
Figure 3
Polydioxanone (PDO) thread after 48 h of immersion in HA. (A) Reflected light microphotography of the thread at 4×. Linear pattern of the hydrolytic attack with emphasis on the central column of the thread, which is seen as an empty band. (B) Representative close-up of multiple regions of the thread that show areas of central hydrolytic degradation with possible loss of mass of the polymer
Figure 4
Figure 4
Polydioxanone (PDO) thread after 72 h of immersion in HA. (A and B) Optical microphotography of the thread at 4× showing a frayed pattern on the periphery of the thread
Figure 5
Figure 5
Polydioxanone (PDO) thread after 72 h of immersion in HA. (A and B) Optical microphotography of the thread at 10×. Arrows show transversal cracks due to migration of the amorphous zone to the crystalline zone of the polymer in the suture
See this image and copyright information in PMC

References

    1. Ali YH. Two years’ outcome of thread lifting with absorbable barbed PDO threads: innovative score for objective and subjective assessment. J Cosmet Laser Ther. 2018;20:41–9. - PubMed
    1. Ilankovan V. Erratum to: recent advances in face lift to achieve facial balance. J Maxillofac Oral Surg. 2017;16:134. - PMC - PubMed
    1. De las Heras C. Técnicas antiptosis con hilos de suspensión subdérmica. [Last accessed on 2018 Apr 10];Revista de la Asociación de Medicina Estética de Castilla La Mancha (AMECLM) 2014 4:17–21. Available from: http://ameclm.org/wp-content/uploads/2012/10/revista_anual_AMECLM_4.pdf .
    1. De Masi E, De Masi F, De Masi R. Suspension threads. Facial Plast Surg. 2016;32:662–3. - PubMed
    1. Rifé M. Trabajo final de carrera. Barcelona-España: Universitat Politécnica de Catalunya; 2007. [Last accessed on 2018 Oct 21]. Síntesis de copolímeros a partir de glicolida y p-dioxanona. Anexo II: Polímeros en suturas quirúrgicas. Available from: https://upcommons.upc.edu/bitstream/handle/2099.1/3104/36143-3.pdf?seque... .