Based on the nature of the therapeutic agent being used, the drug-eluting sutures have effects such as reducing surgical site infections, accelerating wound healing, and reducing other post-operative complications. It can also reduce the need for supplemental drugs. Sustained release of the drug in a specific area can provide the desired therapeutic concentration over a prolonged period of time without exceeding the toxic limit in the systemic circulation. Drug-eluting sutures can be developed using different techniques: coating the suture surface by dip method, coating by grafting or electrospinning. The greatest challenge in the manufacture of a drug-eluting sutures is to achieve the required concentration and effect of the drug without compensating the most important mechanical properties of the suture, which can be achieved with accelerated polymer degradation and controlled release strategies.
Multifilament sutures are susceptible to bacterial adherence and tend to remain trapped within the filament and as a result, multifilament sutures have high risk for surgical site infection. Ophthalmic drug-eluting sutures used in ophthalmic surgery have reduced the rate of bacterial growth and infection in rats. In an in vivo study, inhibition of neointimal hyperplasia, inflammatory response, and formation of granulation tissue with a tacrolimus coated suture in pig model has been reported. Controlled release of the drug prevented neointimal hyperplasia at the site of anastomotic suture by direct diffusion of drugs through the entire vessel wall. This strategy can be effective in both coronary artery bypass graft surgery and peripheral vascular bypass surgery. In addition, scientists have shown that the sutures coated with ibuprofen-loaded polymeric layers exhibit continuous pain relief without changing the mechanical properties of the sutures, and that polyethylenimine coated with dexamethasone and poly (lactic-co-glycolic acid) particles on the absorbable suture surface does not affect the mechanical properties of the suture material for 4 weeks controlled drug release.
The potential of drug-eluting sutures can be extended by the development of drug coated multifilament sutures having high tensile strength, flexibility and better transport properties with sustained release of the drugs, and by producing multidrug coated sutures in combination with synergistic and / or additional effects with limited drug loading at the desired site. On the other hand, complications such as delayed wound healing, severe wound scarring, and skin irritation in barbed sutures require more clinical research. Drug can be placed in angled barbs of barbed sutures to improve functionality and therapy.
- Dennis C. Et al, Suture materials — Current and emerging trends, Journal of Biomedical Materials Research V104, I6 June 2016 Pg 1544–1559