Metal wires staples and ligatures

Metallic Wire

Suture wire is prepared mainly from three metals - nontoxic stainless steel, the alloy tantalum and silver.

         All these may be obtained as a single-strand monofilament suture and the first-two as several strands, either twisted or braided, known as multifilament wire.

         Surgical stainless steel suture wire is used mainly in orthopedics and thoracic surgery. A stouter wire of sizes 3 to 9 (0 to 7) or 29 SWG would be needed for wiring fragments of bone together.

Metal Clips (Ligature)

Ligatures of flattened silver or tantalum wire are used in neurosurgery and chest surgery for arresting hemorrhage from small vessels. The insertion forceps and cartridges allow their use for this purpose at depths with safety.

Metal Clips (Suture)

These are metal clips having two sharp points which when the clip is closed, these points grip the edges of the skin incision and hold them in apposition.

         The original types in use are Michel and Kifa .

Staples

During the past few years there has been considerable development in the field of suture staples.

         These range from disposable magazines of staples which fit an insertion instrument to completely disposable units. Examples of two of the latter are Proximate II (Ethicon) and Appose (Davis and Geck) 

Adhesive skin closures

Steristrip skin closures are sterile strips of Micropore surgical tape, reinforced with polyester filaments, either plain or impregnated with an iodophor, and precut to specific sizes.

         Suture strip is an elastic skin closure strip made to appose skin edges.
nonwoven polyester backing coated with an adhesive 

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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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