Tissue reaction to suture materials in infected surgical wounds--a histopathologic evaluation

Suture materials are foreign bodies which induce and prolong tissue reaction in the wound area. Cellular responses to infected wounds containing 7 suture materials (braided polyglycolic acid [BPGA, Dexon], multifilament stainless steel, monofilament nylon, black braided silk, braided Dacron [Mersilene], and plain and chromic catgut) were studied at 6, 10, 20, and 40 days. Cellular reaction varied with different suture materials. In general, neutrophils were the predominant cells in acute infection, but later, macrophages and fibroblasts predominated. Occasionally, plasma cells, lymphocytes, eosinophils, and giant cells were present. In the infected wounds with implants of plain catgut, chromic catgut, silk, and braided Dacron, there were large numbers of neutrophils even in chronic implantation, indicating persistence of local infection. With nylon, steel, and BPGA, the number of neutrophils rapidly decreased. Although BPGA induced intense acute reaction, the response was mild in chronic implantation. It appeared to be absorbed more slowly than plain or chromic catgut, and tissue reaction was minimal in the absorption stages. A reaction similar to the Splendore-Hoeppli phenomenon was seen around multifilament silk strands in chronic stages of implantation.