Episode 02 — Sutures: Types of Suture Materials скачать в хорошем качестве

Episode 02 — Sutures: Types of Suture Materials

🐑 Catgut *Plain catgut* retains strength for about **10 days**, *Chromic catgut* for about *20 days* 🔬 Absorbable Synthetic Sutures Modern surgery increasingly relies on synthetic absorbable materials, which are *stronger, more predictable**, and **less reactive* than natural catgut. #### 1️⃣ *Polyglycolic Acid (Dexon)* A braided synthetic polymer available in green color. It retains about *55 % tensile strength after 14 days**, **20 % after 21 days**, and is completely absorbed in roughly **100 days* by **esterase enzymes**. Advantages include minimal tissue reaction, uniform absorption, and excellent knot-holding properties. *Uses:* intestinal anastomosis, pedicle ligation, biliary, thyroid, splenic, and cosmetic surgery. #### 2️⃣ *Polyglactin 910 (Vicryl)* A violet-colored braided co-polymer of glycolide and lactide. It retains *55 % of its strength at 14 days**, **20 % at 21 days**, and is absorbed within **60 to 90 days* by slow hydrolysis. It causes very little tissue reaction and handles beautifully. *Uses:* intestinal and laparotomy closure, thoracic and mucosal suturing, cleft palate repair, and pediatric surgery. #### 3️⃣ *Polyglyconate* A monofilament co-polymer of glycolic acid and trimethylene carbonate. It retains *70 % strength for 2 weeks* and **55 % for 3 weeks**, fully absorbed in about **6 months**. It is supple, flexible, and easy to tie. *Used for:* general soft-tissue surgeries. #### 4️⃣ *Polydioxanone (PDS)* A monofilament synthetic suture available in blue, violet, or clear forms. It retains **70 % strength for 2 weeks**, **50 % for 4 weeks**, and is absorbed by 6 months. Ideal when *long-term strength* is required under tension — such as fascia or deeper closures. #### 5️⃣ *Poliglecaprone-25 (Monocryl)* A monofilament co-polymer of glycolide and epsilon-caprolactone. It maintains **60 % strength for the first week**, **30 % for the second**, and is absorbed within **3–4 weeks**. Used where rapid healing is expected and minimal foreign body reaction is desired. --- 🧵 Non-Absorbable Sutures Now, let’s move to materials designed to remain permanently in the tissue unless removed. #### 1️⃣ *Silk* A natural braided suture made from silk filaments. It is black for visibility and though technically absorbable over long periods, it is classified as non-absorbable. It ties smoothly, is inexpensive, and widely used for skin closure and general soft-tissue approximation. *Disadvantages:* higher infection risk and possible granuloma formation. #### 2️⃣ *Nylon (Ethilon, Dermalon)* A synthetic monofilament made from nylon-6 or nylon-66. It is strong, smooth, and causes minimal tissue reaction. However, its strength decreases slowly due to hydrolysis. *Uses:* skin closure, plastic and ophthalmic surgery, and microvascular procedures. #### 3️⃣ *Polyester (Mersilene, Dacron)* A braided synthetic fiber with high tensile strength and minimal tissue reaction. Commonly used for cardiovascular, ophthalmic, and general soft-tissue surgeries. #### 4️⃣ *Polypropylene (Prolene, Surgiline)* A monofilament isotactic crystalline polymer, highly inert and resistant to enzymatic degradation. It remains indefinitely, has a very smooth surface, excellent visibility, and is the *least thrombogenic* of all sutures. *Uses:* plastic, vascular, cardiovascular, tendon, and hernia repair. #### 5️⃣ *Surgical Steel* An iron-nickel-chromium alloy used when maximum strength is required — such as **sternal, abdominal wall, or orthopedic closure**. It is non-absorbable, inert, and encapsulated by fibrous tissue. #### 6️⃣ *Surgical Cotton* A twisted natural cellulose fiber. It is inexpensive and easy to handle but has *high capillarity**, promoting infection, and **poor tensile strength* after autoclaving. Used mostly for general ligation where infection risk is low. --- 🧰 Metal Sutures and Staples Metal clips and staplers, first developed in Hungary by Humer Hultl, provide *fast and reliable closure* and are particularly useful in gastrointestinal surgery. Stapling reduces operative time and tissue trauma. *Skin staples* are also used for skin closure, graft fixation, and emergency lacerations. --- 🧴 Tissue Adhesives and Glues *Cyanoacrylate adhesives* are used for quick skin closure when perfect hemostasis is achieved. **Fibrin tissue glue**, derived from fibrinogen and thrombin, is used for hemostasis in liver, spleen, neurosurgery, ENT, and ophthalmic procedures. --- 🧩 Ligating Clips and Wound Closure Strips *Ligating clips* — absorbable or non-absorbable — offer quick and secure hemostasis in deep or narrow spaces, though they don’t approximate deep tissue well. --- 🩹 Vacuum-Assisted Closure Finally, *vacuum-assisted closure* applies controlled negative pressure to promote uniform wound healing — a modern method that speeds up recovery in complex wounds.