Felis ISSN 2398-2950

Suture materials: absorbable

Contributor(s): Tad Coles, Otto Lanz, David Neck

Introduction

Definition of suture

  • Material used to ligate vessels or approximate tissues.

Historical perspective

  • Celsus - first recorded use of vessel ligation for hemostasis.
  • Galen (200 AD) - used silk suture material.
  • Physick (1800's) - produced absorbable sutures from the skin of goats.
  • Lister (1869) - introduction of suture sterilization and treatment of catgut with chromic acid.
  • 1940's - appearance of synthetic sutures.

Characteristics of ideal suture material:

  • Maintains adequate tensile strength until wound healing well established.
  • Absorbed predictably.
  • Bioinert (minimally reactive, non toxic, non allergenic, non carcinogenic).
  • Sterilized without alteration in physical properties.
  • Preferably monofilament (non capillary).
  • Economical.

 Suture classification

Absorbable vs non-absorbable

Absorbable

  • Undergoes degradation and rapid loss of tensile strength within 60 days.
  • Degradation occurs either through phagocytosis by macrophages brought in during wound healing or by enzyme hydrolysis.

Non-absorbable

  • Retains tensile strength > 60 days.
  • Remains in tissues until removed, although may fragment.  Absorption and loss of tensile strength are different properties. Absorbable sutures may remain in the tissues for > 60 days but retain none of their original tensile strength.

Natural vs synthetic

Monofilament vs multifilament

Monofilament

  • Single strand of material.

Multifilament

  • Consists of multiple strands of material "braided" or twisted to produce a single strand   Suture materials: multifilament  .
  • May serve as a nidus for infection by harboring bacteria in the interstices between strands.
  • "Coating" with various materials may improve their handling characteristics.

Capillary vs. noncapillary

Capillary

  • Sutures absorb fluids and "wick" them along the suture, potentially transporting bacteria into the wound site.
  • Not recommended for use in skin or for penetration of the lumen of a hollow viscus.

Absorbable suture characteristics: natural origin

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Absorbable suture characteristics: synthetic

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Suture size

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Suture selection

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Suture needles

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Further Reading

Publications

Refereed papers
  • Jens B & Bjorling D E (2001)Suture Selection for Lower Urinary Tract Surgery in Small Animals Compendium of Continuing Veterinary Education23(6) 524-528.
  • Molea G, Schonauer F, Bifulco G, DAngelo D (2000)Comparative study on biocompatibility and absorption times of three absorbable monofilament suture materials (Polydioxanone, Poliglecaprone 25, Glycomer 631). Br J Plast Surg53(2), 137-141
  • Boothe H W (1998)Selecting Suture Materials for Small Animal Surgery. Compendium of Continuing Veterinary Education20(2), 155-163
  • Kirpensteijn J, Maarschalkerweerd R J, Koeman J P, Kooistra H S, van Sluijs F J (1997)Comparison of two suture materials for intradermal skin closure in dogs Vet Q19(1), 20-22
  • Debus E S, Sailer M, Ederer J & Thiede A (1997)Physical, biological and handling characteristics of surgical suture material: a comparison of four different multifilament absorbable sutures. Eur Surg Res29(1), 52-61
  • Rodeheaver G T, Beltran K A, Green C W et al(1996)Biomechanical and clinical performance of a new synthetic monofilament absorbable suture J Long Term Eff Med Implants6(3-4), 181-198
  • La Bagnara J (1995)A review of absorbable suture materials in head and neck surgery and introduction of monocryl: a new absorbable sutureEar Nose Throat J74(6), 409-415
  • Bezwada RS, Jamiolkowski DD, Lee IY et al(1995)Monocryl suture, a new ultra-pliable absorbable monofilament suture. Biomaterials16(15), 1141-1148 

Other sources of information

  • Boothe H W (1993)Suture Materials, Tissue Adhesives, Staplers, and Ligating ClipsIn Slatter D. (1993) Textbook of Small Animal SurgerySecond Edition. W.B. Saunders Company, Philadelphia, Pennsylvania.


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