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Suture materials: absorbable

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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

  • Recent references from PubMed and VetMedResource.
  • Jens B & Bjorling D E (2001) Suture Selection for Lower Urinary Tract Surgery in Small Animals. Compendium of Continuing Veterinary Education 23 (6), 524-531 VetMedResource.
  • Molea G, Schonauer F, Bifulco G et al (2000) Comparative study on biocompatibility and absorption times of three absorbable monofilament suture materials (Polydioxanone, Poliglecaprone 25, Glycomer 631). Br J Plast Surg 53 (2), 137-141 PubMed.
  • Boothe H W Jr. (1998) Selecting Suture Materials for Small Animal Surgery. Compendium of Continuing Veterinary Education 20 (2), 155-163 VetMedResource.
  • Debus E S, Geiger D, Sailer M et al (1997) Physical, biological and handling characteristics of surgical suture material: a comparison of four different multifilament absorbable sutures. Eur Surg Res 29 (1), 52-61 PubMed.
  • Kirpensteijn J, Maarschalkerweerd R J, Koeman J P et al (1997) Comparison of two suture materials for intradermal skin closure in dogs. Vet Q 19 (1), 20-22 PubMed.
  • 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 Implants (3-4), 181-198 PubMed.
  • Bezwada R S, Jamiolkowski D D, Lee I Y et al (1995) Monocryl suture, a new ultra-pliable absorbable monofilament suture. Biomaterials 16 (15), 1141-1148 PubMed.
  • LaBagnara J Jr. (1995) A review of absorbable suture materials in head & neck surgery and introduction of monocryl: a new absorbable suture. Ear Nose Throat J 74 (6), 409-415 PubMed.

Other sources of information

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

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