STERNUM KAPATILMASI İÇİN POLİETİLEN/POLYESTER KOMPOZİT MATERYALİN BİYOUYUMLULUĞU: DENEYSEL ÇALIŞMA

Öz

Amaç: Günümüzde cerrahi malzeme çeşitliliğine rağmen bazı dokuların kapatılmasında dayanıklılık yanında esnekliği de olan yeni sütür materyallerine ihtiyaç duyulmaktadır. Özellikle sternum gibi sürekli harekete maruz kalan kemiklerin sütürasyonunda kullanılan paslanmaz çelik sütür materyalleri yeterli sağlamlığı sağlasa bile, bu mikro hareketler nedeniyle kemik doku hasar görebilmekte ve hatta sütürün kendisi de kopabilmektedir. Polyester lifler, polietilen materyaller ve bunların kompozisyonu, sağlam ve elasto-plastik yapıları sayesinde aşırı gerilmeye uğradığında verdiği esneme cevabıyla hem kendine hem de kemik dokuya zarar vermeden doku bütünlüğünü devam ettirebilecek bir sütür materyali olabilir. Daha önce biyomekanik karakteristiğini incelediğimiz bu materyalin biyouyumluluğunu göstermek için bu ön çalışma yapıldı.

Gereç ve Yöntem: 300-350 gr ağırlığındaki 8 erkek Wistar Albino ratın karın ön duvarına 1 cm uzunlukta monofilament paslanmaz çelik tel, multifilaman paslamaz çelik halat, kompozit polyester/polietilen bant, paslanmaz çelik bant parçaları 2’şer cm arayla 4 ayrı alanda subkutan dokuya yerleştirildi. Ayrıca kontrol grubu olarak müdahalesiz 3 rat kullanıldı. İki hafta sonra ratlar kan aspirasyonuyla sakrifiye edildikten sonra sütürleri içerecek şekilde cilt ve cilt altı doku tam kat örneklendi. Doku tamir yanıtı, histopatolojik olarak, fibrozis, histiyositik reaksiyon, vaskülarizasyonve granülositik reaksiyon açısından, 0 ile 3 arasında semikantitatif olarak skorlandırıldı. Elde edilen veriler Mann-Whitney U testi ile değerlendirildi.

Bulgular: Kontrol grubu dahil edilerek yapılan histopatolojik sonuçların karşılaştırılmasında gruplar arası anlamlı fark olduğu ve bu farkın kontrol grubundan kaynaklandığı görüldü. İnflamatuar yanıt parametreleri tüm gruplarda benzer bulundu.

Sonuç: Özellikle güncel kompozit malzemelerin cerrahinin pek çok alanında kullanılması bu materyallerin biyouyumluluğunun incelenmesini zaruri kılar. Bizim çalışmamızda da polietilen-polyester kompozit materyal zaten kullanımda olan diğer sternum kapama materyallerine benzer oranda doku cevabına neden olmuştur.

Anahtar Kelimeler

• Polietilen,polyester,sternum,çelik halat,çelik tel,çelik bant,çelik bant

Biocompatibility of Polyethylene/Polyester Composite Material for Sternum Closure: Experimental Study

Öz

Objective: Despite the diversity of surgical materials today, new suture materials are needed for durability and flexibility in closing some special wounds. When stainless steel suture material is used in the suturing of the bones, especially the sternum, it can cause bone tissue damage due to micro movements and even the suture itself can break off. Polyester fibers, polyethylene materials and their composite forms can be used as a suture material that can sustain tissue integrity in response to stretching without damaging itself as well as the bone tissue due to over-stretching and their robust and elasto-plastic construction. This preliminary study was conducted to demonstrate the biocompatibility of polyethylene/polyester composite material, whose biomechanical characteristics we had previously examined.

Material and Methods: Steel-wire, steel-cable, composite polyester / polyethylene band, stainless steel band were placed in 4 different subcutaneous tissues at intervals of 2 centimeters on the abdominal area of 8 male Wistar Albino rats weighing 300-350 gr. In addition, 3 rats without intervention were used as a control group. After two weeks, the rats were sacrificed by blood aspiration and the cutaneous and subcutaneous tissue were sampled in full thickness to contain suture materials. Tissue repair response was histopathologically scored semiquantitatively for fibrosis, histiocytic reaction, vascularization and granulocytic reaction. The obtained data were evaluated by Mann Whitney U test.

Results: There was a significant difference between groups in the comparison of histopathologic results including control group and it was seen that this difference was caused by the control group. Inflammatory response parameters were similar in all groups.

Conclusion: The examination of the biocompatibility of composite materials is essential as they are used in many branches of surgery. In our study, the polyethylene-polyester composite material also caused a tissue response similar to other sternal closure materials already in use.

Anahtar Kelimeler

• Polyethylene,polyester,sternum,stainless steel cable,sternal wire,sternal steel band

Kaynakça

1. 1. Schimmer C, Reents W, Berneder S, Eigel P, Sezer O, Scheld, H et al. Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial. Ann Thorac Surg. 2008;86:1897-904.
2. 2. Olbrecht VA, Barreiro CJ, Bonde PN, Williams JA, Baumgartner WA, Gott VL et al. Clinical outcomes of noninfectious sternal dehiscence after median sternotomy. Ann Thorac Surg. 2006;82:902-7.
3. 3. Cheng W, Cameron DE, Warden KE, Fonger JD, Gott VL. Biomechanical study of sternal closure techniques. Ann Thorac Surg. 1993;55:737-40.
4. 4. Schimmer C, Sommer SP, Bensch M, Bohrer T, Aleksic I, Leyh R. Sternal closure techniques and postoperative sternal wound complications in elderly patients. Eur J Cardiothorac Surg. 2008;34:132-8.
5. 5. Glennie S, Shepherd DE, Jutley RS. Strength of wired sternotomy closures: effect of number of wire twists. Interact Cardiovasc Thorac Surg. 2003;2:3-5.
6. 6. Alhalawani AM, Towler MR. A review of sternal closure techniques. J Biomater Appl. 2013;28:483-97.
7. 7. Casha AR, Yang L, Kay PH. A biomechanical study of median sternotomy closure techniques. Eur J Cardiothorac Surg. 1999;15:365-9.
8. 8. Kalush SL, Bonchek LI. Peristernal closure of median sternotomy using stainless steel bands. Ann Thorac Surg. 1976;21:172-3.

9. 9. Bhattacharya S, Sau I, Mohan M, Harazi K, Basu R, Kaul A. Sternal bands for closure of midline sternotomy leads to better wound healing. Asian Cardiovasc Thorac Ann. 2007;15:59-63.
10. 10. Orhan SN, Ozyazicioglu MH, Colak A. A biomechanical study of 4 different sternum closure techniques under different deformation modes. Interact Cardiovasc Thorac Surg. 2017;25:750-6.
11. 11. Oh YN, Ha KJ, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Multifilament cable wire versus conventional wire for sternal closure in patients undergoing major cardiac surgery. Korean J Thorac Cardiovasc Surg. 2015;48:65.
12. 12. Dunne B, Murphy M, Skiba R, Wang X, Ho K, Larbalestier R, Merry C. Sternal cables are not superior to traditional sternal wiring for preventing deep sternal wound infection. Interact Cardiovasc Thorac Surg. 2016;22:594-8.
13. 13. Shih CC, Shih CM, Chou KY, Lin SJ, Su YY. Stability of passivated 316L stainless steel oxide films for cardiovascular stents. J Biomed Mater Res A. 2007;80:861-73.
14. 14. Grapow MT, Melly LF, Eckstein FS, Reuthebuch OT. A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation. J Cardiothorac Surg. 2012;7:59-63.
15. 15. Motomatsu Y, Imasaka KI, Tayama E, Tomita Y. Midterm results of sternal band closure in open heart surgery and risk analysis of sternal band removal Artif Organs. 2016;40:153-8.
16. 16. http://www.sternaband.com 26.2.18
17. 17. http://www.dogsan.com.tr/tr-TR/tektel 26.2.18
18. 18. Klink CD, Binnebösel M, Alizai HP, Lambertz A, Junker E, Disselhorst-Klug C et al. Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model. BMC Surg. 2011;11:36-44.
19. 19. Israelsson LA, Millbourn D. Closing midline abdominal incisions. Langenbecks Arch Surg. 2012; 397: 1201-7.
20. 20. Idris SB, Dånmark S, Finne-Wistrand A, Arvidson K, Albertsson AC, Bolstad AI et al. Biocompatibility of polyester scaffolds with fibroblasts and osteoblast-like cells for bone tissue engineering. J Bioact Compat Polym. 2010;25:567-83.
21. 21. Bélanger MC, Marois Y. Hemocompatibility, biocompatibility, inflammatory and in vivo studies of primary reference materials low‐density polyethylene and polydimethylsiloxane: A review. J Biomed Mater Res A. 2001;58:467-77.
22. 22. House HP. Polyethylene in middle ear surgery. AMA Arch Otolaryngol. 1960;71:926-31.
23. 23. Terkawi MA, Hamasaki M, Takahashi D, Ota M, Kadoya K, Yutani T et al. Transcriptional profile of human macrophages stimulated by ultra-high molecular weight polyethylene particulate debris of orthopedic implants uncovers a common gene expression signature of rheumatoid arthritis. Acta Biomater. 2018;65:417-25.
24. 24. Simonian PT, Simonian TL, Simonian LE. Percutaneous Tension-Band Suture Technique for Distal Patella Fracture Fixation. MOJ Orthop Rheumatol. 2017;8(3):315-18.
25. 25. Junge K, Binnebösel M, von Trotha KT, Rosch R, Klinge U, Neumann UP et al. Mesh biocompatibility: Effects of cellular inflammation and tissue remodelling. Langenbecks Arch Surg. 2012;397:255-70.