Suture material
From Wikipedia, the free encyclopedia
Suture material describes any strand of material used to ligate (tie) blood vessels or approximate (being close together) tissues. Sutures are used to close wounds. Sutures and ligatures were used by both the Egyptians and Syrians as far back as 2,000 BC. Through the centuries, a wide variety of materials—silk, linen, cotton, horsehair, animal tendons and intestines, and wire made of precious metals—have been used in operative procedures. Some of these are still in use today.
In the United States, suture size is based on strength and diameter as decided by the United States Pharmacopeia (U.S.P.). The United States Pharmacopeia classification system was established in 1937 for standardization and comparison of suture materials, corresponding to metric measures. The 3 classes of sutures are collagen, synthetic absorbable, and nonabsorbable. This system uses "0" as the baseline, average size suture. As suture diameter decreases, "0's" are added or numbers followed by a "0". As suture diameter increases above "0", numbers are assigned to the suture material. For example, size 5-0, or 00000, is smaller in diameter than size 4-0, or 0000. The smaller the size, the less tensile strength the suture will have.
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[edit] Classificatiion
United States Pharmacopeia classification.
- Class I - Silk or synthetic fibers of monofilament, twisted, or braided construction.
- Class II - Cotton or linen fibers or coated natural or synthetic fibers in which the coating contributes to suture thickness without adding strength.
- Class III - Metal wire of monofilament or multifilament construction.
[edit] Absorbable suture materials
[edit] Plain catgut
- Description
- Absorbable biological suture material. Plain is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. The natural plain thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Plain is absorbed by enzymatic degradation.
- Composition
- plain catgut.
- Tensile strength
- Strength retention for at least 7 days.
- Structure
- Monofilament.
- Origin
- Bovine serosa surface finish.
- Type of absorption
- Proteolytic enzymatic digestion complete by 90 days.
- Tissue reaction
- Moderate. Plain catgut enjoys lower tissue reaction as compared to chromicised.
- Thread color
- Straw.
- Size available
- USP 6-0 (1 metric) to USP 3 (7 metric).
- Sterilization
- E.O. Gas.
- Advantages
- Very high knot-pull tensile strength, good knot security due to special excellent handling features
- Indications
- For all surgical procedures especially when tissues that regenerate faster are involved. General closure, ophthalmic, orthopedics, obstetrics/gynecology and gastro-intestinal tract surgery.
- Contraindications
- Not recommended for incisions that require the sustaining of the tissues for a prolonged period of time.
- Precautions
- Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb the sutures at a higher rate. Cardiovascular surgery, due to the continued heart contractions. It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganisms. Avoid using where long term tissue approximation is needed. Absorption is faster in infected tissues
[edit] Chromic catgut
- Description
- Absorbable biological suture material. Chromic is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. Due to undergoing a ribbon stage chromicisation (treatment with chromic acid salts), the chromic offers roughly twice the stitch-holding time of plain catgut. The natural chromic thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Chromic is absorbed by enzymatic degradation.
- Composition
- Natural purified collagen
- Treatment
- Treatment with a glycerol containing solution and chromic acid salts
- Structure
- Monofilament
- Origin
- Bovine serosa
- Type of absorption
- Proleolytic enzymatic digestion complete in 70 days. Absorption by enzymatic digestion and starts losing tensile strength on implantation from 18–21 days of catgut chromic
- Tissue reaction
- Moderate.
- Thread color
- Brown
- Size available
- USP 6-0 (1 metric) to USP 3 (7 metric).
- Sterilization
- E.O. Gas
- Advantages
- Very high knot-pull tensile strength, good knot security due to special surface finish, improved smoothness due to the dry presentation of the thread, excellent handling features
- Indications
- For all surgical procedures, especially for tissues that regenerate faster.
- Contraindications
- Not recommended for an incision that requires sustaining of the tissues for a prolonged period of time.
- Precautions
- It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganism. Cardiovascular surgery, due to the continued heart contractions. Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb this suture at a higher rate.
[edit] Polyglycolic acid (P.G.A.)
- Description
- It is a synthetic absorbable suture material. Braided synthetic absorbable multifilament made of polyglycolic acid and coated with N-laurin and L-lysine, which render the thread extremely smooth, soft and knot safe.
- Composition
- Polyglycolic acid
- Coating
- Coated with magnesium stearate
- Structure
- Braided
- Origin
- Synthetic
- Type of absorption
- Absorption by hydrolysis complete between 60 and 90 days. Always predictable and reliable
- Tissue reaction ???
- Thread color
- Violet
- Size available
- USP 6-0 (1 metric) to USP 2 (5 metric)
- Sterilization
- E.O. gas.
- Advantages
- High initial tensile strength, guaranteed holding power through the critical wound healing period. Smooth passage through tissue, easy handling, excellent knotting ability, secure knot tying
- Indications
- Subcutaneous, intracutaneous closures, abdominal and thoracic surgeries
- Contraindications
- This suture being absorbable should not be used where extended approximation of tissue is required.
- Precautions
- Special precautions should be taken in elderly patients and patients with history of anemia and malnutrition conditions. As with any suture material, adequate knot security requires the accepted surgical technique of flat and square ties.
[edit] Polydioxanone (PDS)
- Description
- It is a synthetic absorbable suture material. Monofilament synthetic absorbable suture, prepared from the polyester, poly (p-dioxanone).
- Composition
- Polyester and poly (p-dioxanone)
- Coating
- Uncoated
- Structure
- Monofilament
- Origin
- Synthetic through the critical wound
- Tissue reaction ???
- Thread Color
- Violet
- Size available
- USP 6-0 (1 metric) to USP 2 (5 metric)
- Sterilization
- E.O. gas
- Advantages
- Tensile strength retention, guaranteed holding power
- Indications
- PDS is particularly useful where the combination of an absorbable suture and extended wound support is desirable, pediatric cardiovascular surgery, ophthalmic surgery
- Contraindications
- This type of suture being absorbable is not to be used where prolonged approximation of tissues under stress is required and/ or in conjunction with prosthetic devices
- Precautions
- The PDS suture knots must be properly placed to be secure. Conjunctival and vaginal mucosal sutures remaining in placed for extended periods may be associated with localized irritation. Subcuticular sutures should be placed as deeply as possible in order to minimize the erythema and induration normally associated with absorption.
