What is the function, pharmacological effect, and potential side effects of Vicryl (polyglactin 910)?

Vicryl (Polyglactin 910): Function, Pharmacological Effect, and Side Effects

What Vicryl Is and How It Works

Vicryl is a synthetic absorbable suture material (polyglactin 910) that provides temporary wound support during healing and then dissolves through hydrolytic degradation, eliminating the need for removal. 1, 2

Primary Function

• Wound closure and tissue approximation: Vicryl holds tissues together during the critical healing phase, maintaining structural integrity until the body's own collagen can provide sufficient strength 3, 4
• Temporary mechanical support: The suture retains approximately 50-75% of its original tensile strength after 1 week in the body, providing extended support during early wound healing 5
• Complete absorption: The material undergoes complete dissolution through hydrolytic reaction within approximately 35 days, though absorption is predictable and virtually complete by this timeframe 6

Pharmacological Effect (Mechanism of Action)

Vicryl works through mechanical rather than pharmacological action—it is a physical device, not a drug. 3

How the Material Behaves in Tissue

• Absorption mechanism: The suture breaks down through slow depolymerization and dissolution via hydrolysis, not enzymatic digestion 7
• Tissue integration: Once implanted, the material induces a controlled inflammatory reaction that gradually removes the suture as the wound gains strength 5
• Non-antigenic properties: Being a synthetic polymer rather than a protein-based material (like catgut), Vicryl does not trigger allergic or antigenic responses 6
• Fluid absorption: The material has relatively high fluid absorption capacity but low capillary capacity, which affects its handling characteristics 4

Clinical Performance Characteristics

• High tensile strength: Comparable to or superior to non-absorbable synthetic sutures during the critical healing period 4
• Moderate elongation: Provides some flexibility without excessive stretching 4
• Superior handling: Better knot security and ease of use compared to natural absorbable materials like catgut 6, 7

Potential Side Effects and Complications

Minimal Tissue Reaction

• Low inflammatory response: Vicryl consistently produces significantly decreased tissue reaction compared to catgut or collagen sutures 6
• Rare adverse tissue effects: No unfavorable wound reactions have been registered in clinical studies 4
• Slightly prolonged epithelial healing: In corneal surgery, a slightly increased healing time for epithelium was observed in approximately 14% of cases (5 of 35 patients), though this resolved without intervention 8

Infection-Related Considerations

• Standard Vicryl: Does not increase the expected frequency of wound infections beyond baseline surgical risk 4
• Triclosan-coated Vicryl (Vicryl Plus): Actually reduces surgical site infection rates with an odds ratio of 0.67 (95% CI 0.46-0.98) for abdominal fascial closure 5, 1
• Multifilament structure: As a braided suture, standard Vicryl has slightly higher bacterial seeding potential compared to monofilament sutures, though this is clinically insignificant in most applications 2

Mechanical Complications (Technique-Dependent, Not Material-Related)

• Wound dehiscence risk: When used with proper technique (continuous subcuticular closure), Vicryl actually reduces superficial wound dehiscence compared to interrupted non-absorbable sutures (RR 0.08; 95% CI 0.02-0.35) 5
• Tissue strangulation: Only occurs with improper technique—overly tight continuous sutures can strangulate wound edges, but this is a surgical error, not a material defect 5, 2

Long-Term Outcomes

• No increased hernia rates: Follow-up of laparotomy patients 12-18 months postoperatively showed very low frequency of incisional hernias 4
• No anastomotic leakage: No clinical signs of leakage in gastrointestinal anastomoses were registered 4
• No suture-related complications: In a series of 53 general and cardiothoracic surgical procedures, no suture-related complications were observed 7

Important Clinical Caveats

• Not suitable for permanent support: Because Vicryl completely absorbs, it cannot be used where indefinite tissue support is required 5
• Batch consistency: Vicryl provides significantly better batch-to-batch uniformity compared to natural materials like catgut 6
• No removal required: Unlike non-absorbable sutures, Vicryl eliminates the need for a second procedure or anesthetic for suture removal, particularly valuable in pediatric or high-risk patients 2, 8