882 D3000 new imprint Word template Vol 13, No 1 (2025) ISSN 2167-8677 (online) DOI 10.5195/d3000/2025.882 http://dentistry3000.pitt.edu Evaluation of Soft Tissue in Rabbit Utilizing Suture and Tissue Glue Ahmed Amer, Ahmed Abdul Kareem, Sohaib Qais, Saber Mizher, Al-Alaa J. Mowlood, Saif Saad Kamil, Ali Saad Ahmed College of Den*stry, Tikrit University, Tikrit, Iraq Abstract In this work, we sought to determine the efficacy of Bssue glue and sutures in soC Bssue incisions in rabbits. The comparison of Bssue glue and suture for closure of excisional wounds in rabbits showed that the quality of wound healing of cutaneous excisional wounds closed with standard suturing was superior to that of wounds closed with Bssue glue. Open Access Cita%on: Amer A, et al. (2025) Evalua%on of So; Tissue in Rabbit U%lizing Suture and Tissue Glue. Den%stry 3000. 1:a001 doi:10.5195/d3000.2025.882 Received: March 18, 2025 Accepted: March 20, 2025 Published: June 26, 2025 Copyright: ©2025 Amer A, et al. This is an open access ar%cle licensed under a Crea%ve Commons ATribu%on Work 4.0 United States License. Email: ahmedameribraheem@tu.edu.iq Introduc)on Sutures have been the backbone of surgical treatment over the past few decades [1]. Fi- bers or strands called sutures are used to join tissues or blood vessels [2]. In addition to sutures, many additional materials such as clips, staples, and microporous surgical tapes were also employed in surgical proce- dures. Few sutures are absorbed by the body after performing their intended function, these treatments are simple to do, have a high tensile strength, and have no possibility for allergies or cancer [3]. Notwithstanding these benefits, this process is extremely time consuming, and there is a higher risk of in- fection during its removal as well as leaks, tissue scarring, and wound separation [4]. Suture-less approaches must therefore be developed to meet the requirement for less invasive, quicker, and simpler surgical pro- cedures [5]. Trends shift, and the art of dressing wounds has undergone a revolution in the twenty- first century thanks to advancements in syn- thetic polymer technology that produced tissue glue [6]. Adhesives for tissues Surgical glues are a type of biomaterial that closes wounds or tissues by adhering to them after application. Additionally, they aid in the postoperative sealing of air or gas leaks through an incision and the adherence of medical devices to tissues [7,8]. Tissue glues offer a wonderful opportunity to en- hance traditional methods of wound closure. Unlike sutures, they can stop fluid or air leak- age and allow almost instant hemostasis [9]. Requirement of Tissue Glues These adhesives must be quick to prepare, easy to handle, cure rapidly, spread appro- priately due to a well-adjusted viscosity, have sufficient bonding strength in wet envi- ronments and have a modulus-like tissue. Ideally, the material should allow design flexibility for different indications, be cost- effective, cause minimal to no tissue damage, allow wound healing and primarily be bio- compatible and biodegradable [10,11]. Bioadhesion Principles The foundation of surgical adhesives is the concept of bioadhesion, which is the capacity to attach to biological materials and remain on the biological substrate for a predeter- mined amount of time [12]. Chemical and physiological interactions form the founda- tion of the adhesion mechanism. Because of the interaction of the various functional groups contained in adhesives, a chemical bond—either ionic or chemical—is formed between the surfaces of adhesives and bio- logical substrates. Chemical contact involves three primary steps: the polymer is soaked and swells; the polymer chain diffuses into the mucosal membrane; and last, chemical bonds are formed between the entangled chains. Conversely, physiological contact en- tails adhesion via physiologically connected mechanisms such as the blood clotting pro- cess [13]. Advantages Tissue glues are commonly used in the set- ting of traumatic lacerations. Their benefits Evalua&on of So, Tissue in Rabbit U&lizing Suture and Tissue Glue Vol 13, No 1 (2025) DOI 10.5195/d3000/2025.882 http://dentistry3000.pitt.edu 2 in this environment include reduced applica- tion time and reduced pain compared with standard wound-closure methods [9]. Pa- tients also avoid the need to return for re- moval of stitches or skin clips. This can be es- pecially useful in pediatric patients, who might find the application of tissue glue more acceptable than standard methods. How- ever, cosmetic improvement [14]. Categorization Basis of Their Work Hemostats are glues that clot blood and do not work in the absence of blood. A sealant creates a layer of defense to stop fluid or gas leaks. The purpose of an adhesive is to securely join and maintain two surfaces. While hemo- stats work well in the presence of blood, ad- hesives and sealants don't always work well in damp environments [14,15]. Basis of Their Origin 1. Biologic such as fibrin glues and animal de- rived hemostatic agents. 2. Synthetic such as cyanoacrylate and noncy- anoacrylate products, such as polymeric sealant. 3. Genetically engineered polymeric proteins. Fibrin glues are widely used biologic tissue adhesive in surgical practice do not provide significant tensile and adhesive strength and require to be applied on dry substrates. Cyanoacrylates are a class of synthetic glues that rapidly solidify upon contact with weak bases, such as water or blood compared with other tissue adhesives are easier to use, have quicker polymerization [16] and guarantee higher bonding strength. Glubran2 (GEM s.r.l., Viareggio, Italy), a tis- sue adhesive with high adhesive and haemo- static properties, is a class III (f0r internal and external surgical use). Furthermore, it is diffusely applied on skin, eliminating the need for suture removal and providing good cosmertic results [17]. Sutures Surgical sutures are one type of long-estab- lished and necessary medical device, and they play a pivotal role in closing damaged tissues and organs and assisting wound heal- ing postoperatively. Although some prod- ucts, like biomedical glues [18], adhesives, and nails, have been developed as alterna- tives to sutures, it is undisputed that there are still no perfect and fully-fledged alterna- tives to surgical sutures, due to their high stability, feasibility, and applicability. Material Selection for Suture Fabrication Materials originating from both natural and synthetic sources have been employed for the design and fabrication of surgical sutures [19]. Based on the absorbability of the mate- rial, the surgical sutures are further divided into absorbable and non-absorbable types. In general, natural suture materials possess poor tensile strength and unstable perfor- mances [20], while synthetic suture materi- als perform better in this regard, and their degradation properties can be controlled by adjusting the material structures and prop- erties [21]. Natural Absorbable Suture Materials Surgical Catgut Surgical catgut was officially utilized as nat- ural absorbable suture material in the 19th century and was commonly divided into plain surgical catgut and chromic surgical catgut. Since it contains collagen as the main component, surgical catgut could be ab- sorbed in vivo. For instance, the strength of plain surgical catgut could be maintained for at least 7 days and degraded completely after 90 days [22]. Collagen A collagen suture is mainly composed of Type I collagen, which is a fibrous protein with a rod-like helix structure. It has strong physical and mechanical properties and pos- sesses the ability to bind and aggregate with platelets for the formation of a thrombus. Collagen sutures are biocompatible and ab- sorptive, effectively promoting hemostasis and wound healing and relieving postopera- tive pain [23]. Chitin and Chitosan Chitin is an environmentally friendly poly- mer derived from the cell walls of crustacean or fungal cells and is biologically inert and can effectively inhibit postoperative compli- cations or tissue reactions. Generally, chitin fibers can be generated through dry or wet spinning [24]. Synthetic Absorbable Suture It includes: 1- Polyglycolic acid 2- Polylactic acid 3- Poly-lactic-co-glycolic acid 4- Poly(p-dioxanone) Natural Non-Absorbable Suture It includes: 1- Silk 2- Cellulose Synthetic Non-Absorbable Suture It includes: 1- Polyamide 2- Polypropylene 3- Polyethylene terephthalate Healing and Repair of injured Tissues Healing and repair of injured tissues follows several steps in the healthy individual. Fol- lowing birth, the process is initiated by the inflammatory response and subsequent steps are based on this initial response [25]. Whereas wound healing generally leads to a repair of the injured site, it does not lead to tissue regeneration. This difference between repair and regeneration has influence on tis- sues such as ligaments and tendons that function in a mechanically active environ- ment. Thus, the dynamic interface between mechanics and biology influences the effec- tiveness of the healing response. The biology of the host is also influenced by a variety of factors including age, gender, genetics, and tissue history, factors that impact the out- come of the healing response [26]. Defined Steps in the Repair or Healing of a Tissue According to Following Overt In- jury [27] (1) Hemostasis and a rapid inflammatory phase. Acutely following overt injury in an otherwise healthy adult, there is usually pain and bleeding into the area of injury that may be variable depending on the site of injury. (2) The matrix deposition phase. Follow- ing consolidation of the fibrin clot and the temporally regulated influx, proliferation and activation of a subset of cells’ deposition of matrix molecules designed to bridge the damaged area with the residual endogenous ligament tissue begins. (3) The remodeling phase. The remodeling phase is a slow process and is accompanied by alterations not only in matrix remodeling, but also gene expression, cellularity, Evalua&on of So, Tissue in Rabbit U&lizing Suture and Tissue Glue Vol 13, No 1 (2025) DOI 10.5195/d3000/2025.882 http://dentistry3000.pitt.edu 3 vascularity and innervation [27]. Factors that Influence on Soft Healing Process [28] Age It is obvious from everyday life and research that wounds incurred at an early age appear to heal rapidly and without residual scar. Be- cause humans age, the same process follow- ing a similar injury leads to obvious scars. Gender and Hormones It is known in a variety of species that there is a sexual dimorphism in many responses. Females tend to have a more vigorous in- flammatory response than males and as the inflammatory response to injury is a central initial step in the healing process, this is a consistent pattern of observation. It is also known that healing responses in post-meno- pausal women decline separate from the de- cline associated with aging. Application of estrogen can reverse some of these deficien- cies and it is believed to work at the level of macrophages. Macrophages are inflamma- tory cells that can mediate multiple functions in a wound site, including serving as an im- portant source of growth factors and media- tors key for effective wound healing. Genetics Genetic factors play a role in some pathologic scarring or wound healing such as keloid for- mation. However, there is a paucity of infor- mation regarding a definitive role for genetic factors in subtle or not so subtle variations in “normal” healing. Whereas keloid formation is more common in some races than others there is no identifiable link between race and wound healing in other tissues [28]. Materials and Methods Ten sisteen weeks mature, white rabbits were used for this study with a healthy ap- pearance and weight ranging from 1500 to 2500 g. The study was approved by the Tikrit University College of Veterinary Medicine Laboratory Animal Care. All care and surgery were performed in the WSU Laboratory Ani- mal Resources Center under the supervision of doctor Ahmed Khalid. All rabbits were ob- served for 4 days before surgery to verify that they were healthy. The animals were anesthetized with an intramuscular combi- nation of 5 mg/kg xylazine and 35 mg/kg ketamine Envelope skin hlabs 2cm long were performed on shaved right and left legs. One of incision closed with interrupted 0/3 silk sutures and another one closed with hibrin glue. On postoperative day 7, wound closure was scored and evaluated clinically. Parame- ters for clinical assessment of wound healing were summarized in table 1 of numbers was used to evaluate the healing process from (0_10) when 10 score mean complete heal- ing of hlab and every 1mm of wound length failure to healing and complete closure will reduce 1 score from evaluation (Figure 1). Data were analyzed using the SPSS program, using the Paired T-test. Results Based on clinical examinations all flaps which closed by suture shows complete heal- ing without complications while using fibrin glue to close skin incision showed unsatis- factory results and incomplete closing of flaps. Discussion Suturing has been the most widely used method for wound closure because of high reliability of suture materials. However, al- ternative techniques have long been sought, since suturing technique requires skill and experience, a relatively longer time and the need for its removal. Due to these reasons, surgeons are increasingly using tissue adhe- sives over sutures for wound closure. Although most facial wounds heal without complications, owing to the abundant blood supply of the region, mismanagement may result in infection, wound dehiscence, and unsightly and dysfunctional scar [29]. Tissue glue have several advantages over conventional sutures like their fast and pain- less application, rapid setting, which reduces the total operating time and their antibacte- rial properties. Tissue glue itself acts as a wa- terproof dressing and helps in reduction in the number of follow-up visits. As they do not require any needles, accidental needle stick injuries are prevented. However, there are certain disadvantages of tissue glue like their less tensile strength and chances of ad- hesive seepage, if edges are not properly ap- proximated [30]. Conclusion The comparison between tissue glue and su- ture for the closure of excisional wounds in rabbits found that the quality of wounds healing of cutaneous excisional wounds closed with standard suturing was found su- perior to that of wounds closed with tissue glue. References 1. [B.J. Tighe et al. Adhesives and interfacial phe- nomena in wound healing Adv. Wound Repair Ther. (2011). 2. N. Annabi et al. Elastic sealants for surgical ap- plications Eur. J. Pharm. Biopharm. (2015). 3. N. Annabi et al. Surgical materials: current chal- lenges and nano-enabled solutions Nano Today (2014). 4. M. Kazemzadeh-Narbat et al. Surgical sealants and high strength adhesives Mater. Today (2015). 5. S.R. Mobley et al. Surgical tissue adhesives Fa- cial Plast. Surg. Clin (2002). 6. J. Armitage et al. Skin incisions and wound clo- sure Surgery (2011). 7. Kamil, Saif Saad; Khaudhair, Aseel Taha; Hamid, Hind Thyab. Association of Dental Caries with Dif- ferent ABO Blood Groups. 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A prospective com- parison of octyl cyanoacrylate tissue adhesive (dermabond) and suture for the closure of exci- sional wounds in children and adolescents Arch Dermatol. 2001;137:1177-80. Evalua&on of So, Tissue in Rabbit U&lizing Suture and Tissue Glue Vol 13, No 1 (2025) DOI 10.5195/d3000/2025.882 http://dentistry3000.pitt.edu 5 Evalua&on of So, Tissue in Rabbit U&lizing Suture and Tissue Glue Vol 13, No 1 (2025) DOI 10.5195/d3000/2025.882 http://dentistry3000.pitt.edu 6 Figure 1. Representative example of the surgical intervention.