Sutures Ligatures 5 Synthetic non absorbables nylon polyproplene

Synthetic Nonabsorbables

Polyamide (Nylon): Monofilament

This is a single strand of polyamide supplied in sizes ranging from 0. 2 to 2 (10/0 to 2).

         The material can be obtained in multiple precut lengths, from 35 cm to 1 m.

         Polyamide as a single thread is inert and can be safely used in the presence of infection. It may be left in the tissues with very little reaction occurring.

         Monofilament examples of this material include Ethilon, blue (Ethicon); Surgidek, blue or black (Surgicraft); and Dermalon, white, blue or black (Davis and Geck).

Braided

This is used in a similar manner to braided silk. The sizes available range from 0.7 (6/0) to 2(5), with the same tensile strengths as braided silk. The two colors available, black and blue. It is generally supplied in multiple precut lengths of between 35 cm (14 in) and 1 m (40 in), sterile in peel-open packs. The material is available also armed with nontraumatic needles.

         Examples of this material include Nurolon (Ethicon) and Surgilon (Davis and Geck).

Polypropylene

The material is available in sizes 0.2 to 5 (10/0 to 2), with or without needles.

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SUTURES & LIGATURES 4 Non absorbables

NONABSORBABLE LIGATURES AND SUTURES

Nonabsorbable sutures are not generally used in an infected wound as they may cause sinus formation.

Silk

This material, generally white or black, is braided from numerous fine strands of silk. It is supplied on sterilizable spools 20 to
100 m (25 to 125 yds), or in multiple precut lengths ranging from 35 to 45 cm (14 to 18 in), and a single precut length of
1.8 m(72 in).

         The sizes available are 0. 4(8/0) (Virgin silk), and from 0. 7 to 6(6/0 to 4) or even stronger. It is important to use serum-proofed silk to reduce capillary attraction which is a peculiarity of plaited or braided materials. Examples of these materials include D and G silk (Davis and Geck), Mersilk (Ethicon), and Surgisilk (Surgicraft).

         Alternatively, threaded needles can be autoclaved as required for an operation.

Linen

Origin from fibers of flax plant, it has a braided construction, spun and twisted. Relatively pliant and easy to handle. ‘Drags’ through tissues, knots very securely. Evokes minor to moderate tissue reaction. Gains strength on wetting.

Uses

It is used as a general ligature where a strong firm tie is essential.

Cotton

Origin from fibers of cotton bush and is braided is not as strong as silk. Gains strength on wetting.

Uses

It is used similar to silk.

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SUTURES & LIGATURES 3 Synthetic absorbables

Polyglycolic Acid

Dexon (Davis and Geck)

This is a synthetic polymer of glycolic acid. The strands are made by extrusion as fine threads which are then braided to form a uniform gauge thread of seven sizes from 0.7 to 4. Polyglycolic acid sutures are extremely inert and cause minimal tissue reaction.

         Compared with catgut they are stronger, do not fray and are not slippery when knotting. The sutures are sealed in two coverings and sterilized by a two-stage ethylene oxide process. With this method, the inner envelop is sterilized before sealing. Gas sterilizes the outer envelop to complete sterilization, because of the increased strength compared with catgut, in use of Dexon and other sythetic absorbables generally a size smaller than for catgut can be used with safety.

Polyglyconate

Maxon (Davis and Geck)

This is a monofilament synthetic absorbable suture prepared from a copolymer of glycolic acid and trimethy­lene carbonate. The process of absorption is by nonenymatic hydrolysis. Approxi­mately 70% of the original suture strength remains 2 weeks after implantation, and approximately 55% of the original suture strength remains 3 weeks after implantation. Absorption is completed 6 months after implantation.

         Maxon is available in sizes 0.7 (6/0)-3 (2/0)(Clear), and sizes 1(5/0)04(1)(Green), mounted on atraumatic needles.

Polyglactin 910

Vicryl is a pliable, smooth fiber, which is made in nine sizes from 0.3 to 5. Date from implantation studies show that more than 55% of the original strength remains at 14 days, and over 20% at 21 days.
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SUTURES & LIGATURES 2 catgut plain & chromic

ABSORBABLE SUTURE

Catgut (Plain)

The origin is from the intestine of animals and after processing 98% of the extracted material is collagen. Each of the strands is then graded and separated into six metric size: from the thinnest to the thickest, 2(4/0), 3(3/0), 3.5(2/0), 4(0), 5(1), and 6(2)
(The sizes refer to metric gauge, the sizes in brackets are the USP equivalents). The metric size approximates the diameter of the strand in millimeters × 10.

Uses (Fig. above)

The finished catgut is cut into lengths of about 70 cm (30 in) or 1.52 m (5 ft) to form ligatures or ‘needled’ sutures.

         The attachment of nontrau­matic suture needles is a machine procedure.

         There are two basic methods of needle attachment. A hole may be drilled into the blunt end of the needle shaft, or the needle can be flanged at this end to form a groove. Machines are used to close the prepared needle and tightly around the suture material, which is the “pull tested” to ensure that it is firmly attached to the needle. This material is then sterilized and package in a fluid in small easy to handle packages.

Catgut passes through tissues smoothly and easily.

•       It swells and loses its strength at the end of one week, there is loss of 70% of its strength

•       It disintigrates by proteolysis and is rapidly absorbed.

•       There is an inflammatory response to its presence in the tissues.

         It is used as ligature for small vessels and also as a suture for a subcutaneous stitch under the skin.

Catgut (Chromic)

The origin of this suture material is the same as catgut (plain). The material obtained from animal intestine is treated by immersion in a dichromate bath. It is sterilized and package in a similar manner as plain catgut. Its treatment in a chromic bath delays its disintegration and this suture loses 70% of its strength by the end of second week.

Uses

It is used as a ligature from blood vessels and also for suturing the mucosa of the GI tract, urinary tract, respiratory tract, peritoneum and muscle.

         Surgical catgut is wet packaged in alcohol in hermetical sealed pack and presterilized.

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SUTURES & LIGATURE 1

Ligature and Suture Materials

SUTURES AND LIGATURES

In surgery all tissue layers are cut to reach the required organ. On closure all these layers must be stitched back in position accurately to its opposing layer to provide anatomical continuity which was interrupted while opening up the body. Surgeons have made use of sutures and ligatures for achieving closure the following are some available techniques for skin closure.

1.      Needle and suture

2.      Metal ligature

3.      Skin clips

4.      Staples

5.      Adhesive closure

         A suture or a stitch holds cut tissue layers or structure together to help the process of healing.

         A ligature or metal ligature is the use of the material to encircle a cut end of a blood vessel so as to control bleeding. Staples have been used to anastemose hollow organs and vessels. Suture can be:

1.      Absorbable or

2.      Nonabsorbable

         And both these varieties may be made of either natural or synthetic fiber.

NEEDLES

•       These can be with an eye where thread has to be passed through so that two strands pass through the tissues causing trauma.

•       The same is true of spring eye needles.

•       Shapes of needles vary from quarter circle to straight and the shape of the tip of the needle shown in Figures above.

•       A traumatic needle come with the suture material (single strong) attached to the needle .

•           These are presterilized and come in double wraps

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