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Dexon plus versus Maxon fascial closure in morbid obesity: a prospective randomized comparison
M Deitel1, R Alhindawi, M Yamen
1Department of Surgery, University of Toronto, Ont.
Abstract:
A monofilament polyglyconate suture (Maxon) was developed as a longer-lasting suture associated with less potential for infection than braided polyglycolic acid suture (Dexon). The authors compared Dexon Plus and Maxon in a prospective randomized study of 84 consecutive morbidly obese patients who underwent vertical banded gastroplasty. Linea alba was closed with continuous running suture, reinforced with a few interrupted, sutures. After more than 2 years' follow-up, one seroma (2.4%), one wound infection (2.4%) and no hernias were found in the Dexon group. In contrast in the Maxon group there were three seromas (7.1%), four wound infections (9.5%) and four incisional hernias (9.5%, p less than 0.05). The hernias were noted between 2 and 10 1/2 months after the operation in two patients who had had wound infections and in two who had had seromas. When Maxon was used, the needle occasionally pulled off the suture and the ends beyond the knot projected rigidly. Dexon Plus was easier to handle in very fatty wounds.
Insights
In a study comparing surgical sutures, Dexon Plus showed better outcomes than Maxon, with fewer wound infections and hernias. Maxon sutures were associated with a higher risk of complications like incisional hernias.
Area of Science:
- Surgical innovation
- Biomaterials science
- Wound healing
Background:
- Surgical sutures are critical for wound closure and healing.
- Monofilament and braided sutures have different properties affecting performance.
- Polyglyconate (Maxon) and polyglycolic acid (Dexon) sutures are commonly used.
Purpose of the Study:
- To compare the efficacy and safety of monofilament polyglyconate (Maxon) versus braided polyglycolic acid (Dexon Plus) sutures.
- To evaluate complication rates, including seroma, wound infection, and incisional hernia, after vertical banded gastroplasty.
Main Methods:
- Prospective randomized study involving 84 morbidly obese patients undergoing vertical banded gastroplasty.
- Linea alba closure using continuous running and interrupted sutures with either Dexon Plus or Maxon.
- Follow-up exceeding 2 years to assess wound complications.
Main Results:
- The Dexon Plus group experienced one seroma (2.4%) and one wound infection (2.4%), with no hernias.
- The Maxon group had three seromas (7.1%), four wound infections (9.5%), and four incisional hernias (9.5%, p < 0.05).
- Maxon sutures exhibited handling difficulties, including needle detachment and rigid knot ends, while Dexon Plus was easier to manage in fatty tissue.
Conclusions:
- Braided polyglycolic acid (Dexon Plus) sutures demonstrated superior outcomes compared to monofilament polyglyconate (Maxon) sutures in vertical banded gastroplasty.
- Maxon sutures were associated with a significantly higher incidence of incisional hernias and other wound complications.
- Dexon Plus is recommended for linea alba closure in this patient population due to better handling and lower complication rates.