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Suture materials: non-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.
  • 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.
  • 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.

Non-absorbable suture characteristics: natural origin

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Non-absorbable suture characteristics: synthetic

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Non-absorbable suture characteristics: miscellaneous

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Suture size and selection

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Suture needles

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Bellah J R (1994) Surgical stapling of the spleen, pancreas, liver, and urogenital tract. Vet Clin N Am: Small An Prac 24 (2), 375-394 PubMed.
  • Kirpensteijn J, Fingland R B & Boyer J E Jr. (1993) Comparison of stainless steel fascial staples and polypropylene suture material for closure of the linea alba in dogs. Vet Surg 22 (6), 464-472 PubMed.
  • Hampel N L, Johnson R G &  Pijanowski G J (1991) Effects of isobutyl-2-cyanoacrylate on skin healing. Compend Contin Educ Pract Vet 13 (1), 80-83 VetMedResource.
  • Pavletic M M (1990) Surgical stapling devices in small animal surgery. Compend Contin Educ Pract Vet 12 (12), 1724-1741 VetMedResource.
  • Court M H & Bellenger C R (1989) Comparison of adhesive polyurethane membrane and polypropylene sutures for closure of skin incisions in cats. Vet Surg 18 (3), 211-215 PubMed.
  • Smeak D D & Wendelburg K L (1989) Choosing suture materials for use in contaminated or infected wounds. Compend Contin Educ Pract Vet 11 (4), 467-475 VetMedResource.

Other sources of information

  • Lawrence D L, Salmeri K R & Bloomberg M S (1990) Suture materials. In: VEM 5402 Introduction and Small Animal Soft Tissue Surgery of Domestic Animals. U of FL Coll Vet Med Spring.
  • Bojrab M J (1988) Suture Use Manual. Copyright, Pitman-Moore Inc. pp 1-23.
  • Boothe H W (1985) Suture materials and tissue adhesives. In: Textbook of Small Animal Surgery. Ed D H Slatter. W B Saunders Co, Philadelphia. pp 334-344.
  • Suture materials. In: Fundamental techniques in Veterinary Surgery. Eds C D Knecht et al W B Saunders Co, Philadelphia. pp 28-50.

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