Uticaj različitih vrsta hirurčkih konaca i stepena njihove kolonizacije mikrorganizmima na zarastanje hirurških rana u usnoj duplji

Abstract

Primarno zarastanje hirurških rana najčešće se obezbeđuje uz pomoć hirurških konaca. Ne samo da se koncima postiže približavanje ivica rane, već oni služe i kao podrška tkivu u prvim danima zarastanja dok tkivo ne postigne zadovoljavajuću zateznu čvrstoću. U savremenoj oralnoj hirurgiji, za uspeh terapijske procedure često su neophodni apsolutna stabilnost rane i odsustvo dehiscencije u postoperativnom periodu. Stabilnost rane u velikoj meri zavisi od kvalitativnih svojstava hirurških konaca. Hirurški konci se dele na prirodne i sintetske; monofilamente i multifilamente; resorptivne i neresorptivne. Najvažnije odlike hirurških konaca jesu biokompatibilnost, plak prijemčivost, lakoća rukovanja i zatezna čvrstoća. Cilj ove studije bio je da se ispitaju i međusobno uporede 4 različite vrste hirurških konaca u pogledu uticaja na zarastanje mekog tkiva, plak prijemčivosti, tkivne reakcije koju izazvaju kao i relevantnih kliničkih parametara koji utiču na upotrebnu vrednost hirurških konaca. U studiju je bilo uključeno 32 pacijenta kod kojih je bilo indikovano hirurško vađenje sva 4 impaktirana umnjaka. Posle vađenja sve rane su ušivene različitim koncima. Klinički parametri ocenjivani su u toku operacije i na postoperativnim kontrolnim pregledima. Procena zarastanja mekog tkiva vršena je 3. i 7. dana postoperativno koristeći odgovarajući indeks zarastanja. Posle uklanjanja konaca 7. dana postoperativno određena je količina mikroorganizama na uzorcima konaca. Urađena je i histološka analiza uzoraka konaca i na osnovu broja ćelija indirektno je procenjena jačina inflamatorne reakcije u tkivu. Rezultati su pokazali da je zarastanje mekog tkiva značajno bolje oko monofilamentnih konaca u odnosu na multifilamentne konce, kao i oko sintetskih konaca u poređenju sa koncima od prirodnih materijala...

Primary wound healing is most frequently obtained by means of surgical sutures. Not only are sutures used to approximate wound edges but they also support tissue during early phase of healing until it regains enough tensile strength. In order to achieve successful outcome, contemporary procedures in oral surgery often require absolute wound stability as well as absence of dehiscence in the postoperative period. Wound stability is determined by inherent characteristics of suture materials to a great extent. Suture materials can be natural or synthetic; monofilament and multifilament; absorbable and non – absorbable. Essential features of suture materials are related to physical/mechanical, biocompatibility, biodegradation and handling properties. The aim of this study was to compare 4 different suture materials in terms of the influence on wound healing, microbial adherence, tissue reaction and relevant clinical parameters which determine their clinical value. Total number of 32 patients undergoing surgical extraction of four impacted third molars were involved in the study. Each wound after tooth removal was sutured with different thread. Clinical parameters were estimated intraoperatively and during the control check-ups. Soft tissue healing around sutures were evaluated on the 3rd and 7th day postoperatively. After suture removal microbial colonization was assessed. Also, histological analysis was done and according to number of inflammatory cells indirect assessment of the degree of tissue inflammatory reaction was made. Results revealed significantly better soft tissue healing around monofilament and synthetic sutures compared to multifilament and natural ones respectively. Although it was found association between microbial load and soft tissue healing on the 7th day postoperatively it was not statistically significant. Soft tissue healing was significantly better around all sutures on the 7th day than on the 3rd day postoperatively...