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

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

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.

Keywords:

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

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