Suture materials Thursday, October 8, 2020 4:12 PM Suture Materials ‘Suture material] filament | Absorbing ] Tissue | Tensile | Tensile | cost ses properties | reaction | strength | strength retention plaingwt collegen — moderate | poor Days [low Tnside the wound where it absorbsand wound healing is guick chromic gut | collegen absorbable | moderate | poor TO days [Tow Inside the wound where it | ‘hots ond isla time is average length polygalactc | braided absorbable | mild poor TS weeks [moderate | Inside de wound where it acid (Viery!) absorbsand longer wound healing time is required, such as tendons. sik braided high poor Tyear Tow Skin closure or Bscia lon momfiliment | Noa Verylow | good Loses [low Sin closure or Bscia or absorbable 20% where long term strength is needed Polypropylene | monofiliment | Non- ‘minimal | excellent | indefinite | high Sub-coticuar skin closure or (Prolene) absorbable fascia or where permanent strength is needed Polyester braided Noa. ‘minimal | good indefinite | high Tstermally where low reaction (ersilene) absorbable braided suture is required to allow tissue to adhere to it, Stanlesssteel | monnfiliment | Non- Tow cacellent | indefinite [moderate | Bone , tendons, strong absorbable comective tissue where permanent strength is required Suture Material The purpose of a suture ~ to hold a wound together in good apposition Until such time as the natural healing process is sufficiently well established to make the support from the suture material unnecessary and redundant. ‘ofa suture will depend on: ~ Properties of suture material = Absorption rate, handling characteristics and knotting properties ~ Size of suture ~ Type of needle Natural suture materials = Absorbable © Catgut- Plain or chromic ~ Non-Absorbable © Silk © Linen © Stainless Steel Wire © Cotton Synthetic suture materials = Absorbable (© Polyglycolic Acid (Dexon) © Polyglactin (Vicry!) © Polydioxone (PDS) © Polyglyconate (Maxon) = Non-Absorbable © Polyamide (Nylon) © Polyester (Dacron) © Polypropylene (Prolene) © Ethilon - polyamide ( monofilament ) © Dafilon — polyamide ( monofilament ) Absorbable suture are broken down by either: ~ Proteolysis (e.g. Catgut) ~ Hydrolysis(e.g.Vieryl, Dexon) catgut = Made from the submucosa of sheep gastrointestinal tract = Broken down within about a week ~ Chromic acid delays hydrolysis ~ Even so itis destroyed before many wounds have healed silk ~ Strong and handles well but induces strong tissue reaction = Capillarity encourages infection causing suture sinuses and abscesses Viery! ~ Tensile strength © 65% @ 14 days © 40% @ 21 days, © 10% @ 35 days ~ Absorption complete by 70 days Polydioxone ~ Tensile strength © 70% @ 14 days, © 50% @ 28 days © 14% @ 56 days ~ Absorption complete by 180 days Common errors of suture use ~ Too many throws. Increases foreign body size. Causes stitch abscesses ~ Intra-cuticular rather than subcuticular sutures causing hypertrophic scars ~ Holding monofilament sutures with instruments reduces tensile strength by over 50% ~ Holding butt of needle causes needle and suture breakage Absorbable Nonabsorbable Physical ————— Configuration Material Trade name Material Trade name Monofilament —Polyglecaprone — Monocryl Polypropylene Prolene 25 Glyconate — Monosyn Polyamide 6/6 —_Ethilon Polyglyconate Maxon e Glycomer 631 Biosyn Polydioxanone PDS Il Pseudo- _ Polyamide 6 Supramid monofilament Multifilament — PGA* Dexon II Polyester Ethibond Polyglactin 910 Vicryl PGA Safil Quick & Polyglactin 910 Vicry! rapid Multifilament Silk Perma-Hand ®PGA = polyglycolic acid.