Absorbable or nonabsorbable suture materials for closure of the dura mater?

Abstract

This study was undertaken to determine which suture material would give the best results for closure of the dura mater. Because there is no need for the suture to remain longer than until healing has occurred and as remaining foreign material will predispose to foreign body reactions and infection, it was considered important to test new absorbable materials like polyglactin 910 (Vicryl) and polyglycolic acid (Dexon) for closure of the dura mater. The reactions from these materials were compared to those of silk and polyester (Ethibond) in dogs 60 days after the suture of dural incisions. The quality of healing with respect to the smoothness of the subdural surface, the presence of adhesions between sutures and the brain surface, the degree of absorption of the material, and reactions around the sutures were evaluated. Vicryl gave the best results, providing a smooth subdural surface without adhesions. It was almost totally absorbed when healing was completed, in contrast to Dexon and the other materials. The cellular reaction around Vicryl was slight. Silk, Ethibond, and Dexon protruded from the subdural surface and adhesions to the arachnoid were common. When the dura mater was removed, these adhesions tore off the leptomeninges with their vascular supply to the cortex. The results of these experiments seem to justify the recommendation of Vicryl for suturing of the dura mater. Such an absorbable material decreases the risk of foreign body reactions, and infections will be more easily combated because of the absence of foreign material. The lack of subdural adhesions is an advantage if reoperation is necessary.