Adverse events of sutures: possible interactions of biomaterials?

Absorbable sutures are in use for more than 30 years. Tissue reactions which might be associated with suture material have rarely been reported in the past. After a long period without complications caused by suture material we observed 12 cases of unexpected tissue reactions after clean operations. Our patients 3-8 weeks after uneventful elective clean operations (varicose vein, hernia, benign soft tissue tumor) had unexpected tissue reactions (inflammation, granuloma, extrusion, fistula, abscess) in the vicinity of Vicryl, suture material (8 cases with Vicryl, 4 cases with Vicryl plus. After removal of the suture material and the granulomatous tissue wounds healed without any further disturbance. These tissue reactions have been observed in patients with subcuticular sutures as well as in patients with deeper located vein ligatures. It is well known that next to patient-associated and surgeon-related factors biomaterials might have an impact on postoperative inflammatory process and healing. We use Vicryl, suture material for ambulatory surgery since 1999 and did not see complications for a long period up to now. 11 of the patients were observed within several weeks in summer 2005, whereas only one patient has been observed in the year 2004. All 11 patients observed in 2005 had a combination of Vicryl/ Vicryl plus suture material in deep/subcutaneous and Dermabond glue for skin closure. We do not know the cause for this change. For clarification evaluation of the tissue reactions of these biomaterials including possible interactions or combined reactions should be done.