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(Basicscience) 16 nov suture materials

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Akhmad Muhajir

Natural absorbable sutures like plain gut and chromic gut degrade at different rates, with plain gut losing strength within 7-10 days and fully absorbing by 70 days, while chromic gut maintains strength for 10-21 days and absorbs fully by 90 days. Synthetic absorbable sutures including polyglactin, polytrimethylene carbonate, and poliglecaprone are also discussed. Nonabsorbable sutures like surgical steel, silk, cotton, and linen do not degrade in tissue and are useful for percutaneous closures. Common synthetic nonabsorbable sutures used in cutaneous procedures are nylon, polypropylene, and polybutester.

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Natural Absorbable Plain gut elicits a marked inflammatory reaction in tissue and maintains its tensile strength for only 7-10 days after implantation. Generally, it is completely absorbed by 70 days; however, loss of strength and absorption vary greatly. Chromic gut is plain gut treated with chromium salts to slow absorption and decrease tissue reactivity by cross-linking the collagen. Its tensile strength is maintained for as long as 10-21 days, and complete absorption does not occur until at least day 90.
Synthetic Absorbable Polyglactin (Vicryl; Ethicon) Polytrimethylene carbonate (Maxon; Syneture) Poliglecaprone(Monocryl; Ethicon)
Nonabsorbable suture material Nonabsorbable sutures are defined by their resistance to degradation by living tissues. They are most useful in percutaneous closures. Surgical steel, silk, cotton, and linen are natural materials Synthetic nonabsorbable monofilament sutures are most commonly used in cutaneous procedures and include nylon, polypropylene, and polybutester Synthetic nonabsorbable braided sutures composed of nylon and polyester are used infrequently in dermatologic surgery
Nonabsorbable Material Silk Nylon Polyester Polypropylene Polybutester
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(Basicscience) 16 nov suture materials

  • 1. Natural Absorbable Plain gut elicits a marked inflammatory reaction in tissue and maintains its tensile strength for only 7-10 days after implantation. Generally, it is completely absorbed by 70 days; however, loss of strength and absorption vary greatly. Chromic gut is plain gut treated with chromium salts to slow absorption and decrease tissue reactivity by cross-linking the collagen. Its tensile strength is maintained for as long as 10-21 days, and complete absorption does not occur until at least day 90.
  • 2. Synthetic Absorbable Polyglactin (Vicryl; Ethicon) Polytrimethylene carbonate (Maxon; Syneture) Poliglecaprone(Monocryl; Ethicon)
  • 3. Nonabsorbable suture material Nonabsorbable sutures are defined by their resistance to degradation by living tissues. They are most useful in percutaneous closures. Surgical steel, silk, cotton, and linen are natural materials Synthetic nonabsorbable monofilament sutures are most commonly used in cutaneous procedures and include nylon, polypropylene, and polybutester Synthetic nonabsorbable braided sutures composed of nylon and polyester are used infrequently in dermatologic surgery
  • 4. Nonabsorbable Material Silk Nylon Polyester Polypropylene Polybutester

Editor's Notes

  • #5: Silk is a soft, pliable suture material that is comfortable for patients and unlikely to tear through even delicate tissues. As a result, it is a good choice for use in mucosal tissues or intertriginous areas. Silk also is useful as a temporary suture to elevate or retract tissues for improved visibility during surgery. It is available in black. It is a braided material formed from the protein fibers produced by silkworm larvae. Although silk is considered a nonabsorbable material, it is gradually degraded in tissue over 2 years. Polyester is a braided synthetic suture with uses similar to those of braided nylon. It has high tensile strength, with good handling, good knot security, and relatively low tissue reactivity. Polyester is available in a coated form that decreases tissue drag. It is a pliable, soft suture similar to silk and can be used in mucosal tissues or intertriginous areas. Additional suture tensile strength can be achieved when polyester is braided or blended with other synthetic fibers such as polyethylene in products like Ethibond (Ethicon) and Mersilene (Ethicon). These sutures, however, are costly and infrequently used for skin closure but instead on deep tissues such as tendon or fascia. Polypropylene (Prolene, Ethicon) is a monofilament synthetic suture that was introduced in 1962. Its tensile strength is lower than that of the other synthetic nonabsorbable sutures. Its handling, tying, and knot security are poor as a result of its stiff nature and high memory. An additional throw is needed for adequate knot security. A method to improve security is the use of thermocautery to fuse the knots or transform the ends into small beads. Tissue reactivity is extremely low for polypropylene, and, unlike nylon, gradual absorption does not occur if it is buried in tissue. As a result, polypropylene is an excellent choice for a buried suture for long-term dermal support. The newest monofilament nonabsorbable synthetic suture is polybutester (Novafil; Syneture). This suture combines many of the desirable characteristics of polypropylene and polyester.