Antimicrobial Surgical Sutures: Recent Developments and Strategies

Surgical sutures are probably the most widely used medical devices in healthcare applications for wound closure. During their application, sutures may be exposed to microorganisms present in the environment leading to bacterial biofilm formation, and thereon to surgical site infections. The physicochemical characteristics of the polymeric substrate play a major role in directing the behavior of the suture in a biological milieu. In such a context, it is necessary to develop sutures which actively repel and inhibit bacterial adherence and colonization on their surfaces. Drug eluting sutures have been proposed as a solution to this dilemma. Currently, bioactive agents (natural or synthetic) are being incorporated in polymeric materials via various methods including blending and compounding, surface functionalization and conjugation, and coating to render antimicrobial surgical sutures. However, each of these methods has its own pros and cons. Depending upon the nature of the substrate, an appropriate processing technique has to be chosen. In this article, we review the recent state-of-the-art developments and strategies in antimicrobial surgical suture fabrication. The efficacy and mechanism of these sutures in controlling infection is critically analyzed. However, such bioactive agent incorporated sutures have to be tested in clinically randomized trials to accurately gauze their applicability in a surgical setting. Presently, very few antimicrobial surgical sutures are available commercially. Therefore, there is a great scope for market development in this area.