Is Prolene (polypropylene) 4-0 (double arm) used in Modified Radical Mastectomy (MRM)?

Use of Prolene 4-0 (Double Arm) in Modified Radical Mastectomy

Prolene 4-0 (double arm) is not typically recommended for use in Modified Radical Mastectomy (MRM) procedures, as absorbable sutures like polyglactin 910 (Vicryl) or poliglecaprone 25 (Monocryl) are preferred for better outcomes and reduced surgical site infection risk. 1

Recommended Suture Materials for MRM

Primary Recommendations

• Absorbable sutures are the standard choice for MRM procedures:
  • Polyglactin 910 (Vicryl) - preferred for deep tissue closure
  • Poliglecaprone 25 (Monocryl) - excellent for subcuticular closure
  • Triclosan-coated versions of these sutures are strongly recommended to reduce surgical site infection risk 1

Rationale for Absorbable Sutures

1. Infection Prevention: Triclosan-coated absorbable sutures significantly reduce surgical site infection risk compared to non-coated alternatives (odds ratio 0.72,95% CI 0.59–0.88) 1

2. Wound Support: Absorbable sutures like polyglactin 910 maintain 50-75% tensile strength after 1 week, providing extended support during critical healing periods 1

3. Cosmetic Outcomes: Subcuticular closure with absorbable sutures provides superior cosmetic results 1

4. Absorption Timeline:

   • Standard polyglactin 910 (Vicryl): 60-90 days
   • Poliglecaprone 25 (Monocryl): 91-119 days
   • Vicryl Rapide (fast-absorbing): 42 days 1

Why Not Prolene?

Prolene (polypropylene) is a non-absorbable monofilament suture that has several disadvantages in MRM:

1. Requires Removal: As a non-absorbable suture, Prolene would need to be removed after healing, creating unnecessary discomfort and additional visits for the patient

2. Infection Risk: While Prolene is a monofilament suture (which generally causes less bacterial seeding than multifilament sutures), the triclosan-coated absorbable options provide superior infection prevention 1

3. Cosmetic Concerns: Non-absorbable sutures like Prolene may lead to poorer cosmetic outcomes compared to subcuticular closure with absorbable materials 1

Surgical Technique Considerations in MRM

Modified radical mastectomy involves:

• Complete removal of breast tissue
• Preservation of pectoralis major muscle
• Axillary lymph node dissection 2

Key surgical considerations include:

• Meticulous hemostasis to prevent hematoma formation 1
• Avoiding excessive tissue tension 1
• Proper specimen orientation 1
• Preservation of subcutaneous tissue with separate closure 1

Postoperative Complications

Common complications following MRM include:

• Wound infections (reported in approximately 11.4% of patients) 3
• Seroma formation (reported in approximately 23% of patients) 3

These complications can lead to:

• Longer hospital stays
• Delayed adjuvant therapies
• Increased patient suffering 3

Best Practices for Wound Closure in MRM

1. Layer-by-Layer Closure:

   • Deep tissue: Polyglactin 910 (Vicryl)
   • Subcutaneous: Polyglactin 910 or poliglecaprone 25
   • Subcuticular: 5-0 poliglecaprone 25 (Monocryl) or polyglactin 910 (Vicryl) 1

2. Antimicrobial Considerations:

   • Always choose triclosan-coated sutures when available 1
   • Monofilament sutures may cause less bacterial seeding than multifilament types 1

3. Nerve Protection:

   • Special attention to preserving the anterior thoracic nerve and intercostobrachial nerve to prevent numbness, swelling, and pain in the upper medial arm 4

In conclusion, while Prolene 4-0 (double arm) is a reliable suture material in many surgical settings, it is not the optimal choice for MRM procedures. The evidence strongly supports using triclosan-coated absorbable sutures like Vicryl or Monocryl for better infection prevention, wound healing, and cosmetic outcomes.