Plus Sutures for preventing surgical site infection

Plus Sutures (Ethicon, Johnson & Johnson Medical) is a range of synthetic, absorbable sutures that are either impregnated with or coated with triclosan (Irgacare MP), a purified medical grade antimicrobial, depending on the suture type. Absorbable sutures are absorbed by tissue over a period of time and do not need removing. The 3 sutures considered in this evaluation are indicated for general soft tissue approximation and ligation. Each has different physical properties and absorption rates, which affects which tissue types it is best suited to:

• Coated VICRYL Plus Antibacterial (polyglactin 910) Suture is a multifilament suture (multiple braided threads). VICRYL Plus retains 75% of its original tensile strength at 2 weeks after implantation; 40% to 50% at 3 weeks and 25% at 4 weeks. Complete absorption happens between 57 days and 70 days.

• MONOCRYL Plus Antibacterial (poliglecaprone 25) Suture is a monofilament suture (solid and smooth thread). MONOCRYL Plus retains 50% to 60% of its original tensile strength at 1 week and 20% to 30% at 2 weeks. Complete absorption happens between 91 days and 119 days. This suture is also available in a barbed design for knotless suturing (STRATAFIX Plus) but this version of the technology was not included in the evaluation.

• PDS Plus Antibacterial (polydioxanone) Suture is a monofilament suture (solid and smooth thread). PDS Plus Antibacterial retains 60% to 80% of its original tensile strength at 2 weeks, 40% to 70% at 4 weeks, and 35% to 60% at 6 weeks. Complete absorption happens between 182 days and 238 days. This suture is also available in a barbed design for knotless suturing (STRATAFIX Plus) but this version of the technology was not included in the evaluation.
  
  PDS Plus and MONOCRYL Plus contain no more than 2,360 micrograms/metre triclosan. VICRYL Plus has a coating of copolymer and calcium stearate as well as up to 472 micrograms/metre triclosan. The absorption rates and handling properties are the same as non-triclosan sutures.

Plus Sutures is innovative because sutures are coated or impregnated with triclosan (Irgacare MP). Triclosan is a broad-spectrum antibacterial agent. It helps reduce biofilm formation and bacterial colonisation, preventing the growth of most common organisms associated with surgical site infection for at least 7 days. Plus Sutures is already used in the NHS.

Plus Sutures would replace using non-triclosan absorbable sutures for wound closure in people that have had a surgical procedure, when absorbable sutures are an appropriate option. Plus Sutures should be used as part of a locally agreed bundle of care to reduce surgical site infections. Clinical experts reported that the handling properties of Plus Sutures were identical to non-triclosan sutures. Adopting Plus Sutures would not alter the current care pathway or need any additional training. The technology is already used extensively within the NHS.

The cost of Plus Sutures is around £4.25 per suture, based on average prices of the 3 suture types.

For more details, see the Johnson & Johnson webpage on Plus Sutures.