Nonabsorbable sutures can be used for most types of soft tissue repair, including cardiovascular and neurological procedures. The timeframe for an absorbable suture to dissolve can vary wildly, from about ten days to as long as a few months.
It may depend on the surgical procedure, type of wound or incision being closed, the suture material type, and the size of the suture. Once again, this varies, usually depending on where they are on the body. The following, as noted by the American Family Physician , provides a good guideline:.
While sutures have stood the test of time, they still present a number of challenges:. Learn more about the power of BandGrip here. Clinical studies are demonstrating outstanding clinical results and strong physician and patient preferences for BandGrip over sutures for closing wounds. Derived from purified catgut, collagen, sheep and cow intestines, these natural sutures are used in the repair of internal soft tissue wounds or lacerations. Additionally monofilaments tend to be susceptible damage from instrumentation which can result in catastrophic damage from crushing.
Monofilament suture is typically smooth and hence has lower tissue drag and capillary action. Multifilament suture is either a braid or twist of smaller strands. Multifilament sutures are generally stronger and more pliable than a monofilament of the same material and size. The surface of multifilament suture is frequently rough and hence has greater tissue drag but frequently improved knot security.
Due to the presence of multiple filaments multifilament sutures have greater capillarity and an increased tendency for bacterial colonisation. Many multifilament sutures are treated with a coating to improve suture handling and decrease tissue drag and capillary action; however, these coatings frequently decrease knot security.
Non-absorbable sutures despite been classified as non-absorbable are frequently susceptible to degradation and can lose tensile strength over time. There is no single suture that is the ideal suture. The theoretical ideal suture has the following properties:. Adequate tensile strength. Minimal tissue reaction. Inhibits bacterial growth. Handles easily. Secure when knotted. Absorbed after tissue healed. Not corrosive. Not toxic. Easily sterilised. A natural suture made from the small intestinal submucosa of sheep or the intestinal serosa of cattle and is available in plain or chromic forms.
Catgut is relatively weak compared with other sutures and has a non-uniform profile which results in non-uniform strength. Catgut incites an inflammatory reaction and is absorbed by an enzymatic process. Consequently the absorption is extremely variable depending on local conditions and extent of inflammation. Numerous choices for a suture material are available, including biodegradable sutures.
Biodegradable material can be viewed as well suited for applications in which the suture is no longer required after healing has occurred.
However, for repairs of tissues that are subjected to high mechanical demands, degradable sutures are often not utilized by the surgeon. This has mainly to do with uncertainty regarding the expected duty life of the sutures related to their progressive hydrolysis and corresponding loss of mechanical integrity. While several studies have described the biomechanical properties of large diameter surgical sutures in various conditions, these studies neglect the effect of time [ 12 , 14 , 19 , 20 ].
Therefore, the aim of this study was to provide data on the mechanical properties of the most common suture materials used in orthopedics. In particular, the changes of the material properties during an observation period of 56 days were investigated. One limitation of this study was the use of an in vitro conditioning of the materials that did not comprise cyclic load.
Such loads can be expected to result in material creep, and how this effect may influence the long-term properties of the sutures may be considered in future tests. In any case, there were no significant differences in load to failure with and without cyclic load. The environmental factors during the incubation time pH 7.
Regarding the here investigated mechanical properties, we are confident that using standardized in vitro conditions simulating the wet and warm milieu of the body reproduces the in vivo conditions adequately. Using an in vivo model would be useful to test the combined development of tissue and suture, but would be less useful to test the development of the suture properties alone. We confirmed that Vicryl rapide and Monocryl lose their mechanical strength relatively quickly, with an effective loss of integrity after an incubation period of 14 and 28 days, respectively.
Due to the early degradation, other properties including maximal strain and stiffness also showed significant changes in the first weeks. These materials appear to be only suitable for situations in which rapid healing is expected, with minimal longer-term mechanical demands.
This would concern applications such as in ligations or skin closure, where for example subcutaneous irritation makes early absorption desirable. Regarding the consequences on the best choice of suture material for the orthopedic surgeon, of course the final decision is to be made by individual surgeon.
However, in the case of degrading sutures, there is a race between increasing strength of the developing scar and decrease of the sutures properties. Particularly, the elasticity of the suture may be beneficial to compensate for sudden but rare spikes in loading on the suture-repair construct, in order to prevent failure or breakage.
We could show that particularly PDS will preserve its advantageous properties over the time of absorption, with corresponding lower maximum tensile strength. The three absorbable sutures Vicryl, PDS, and Maxon all could sustain higher loads during the first 2 weeks than the non-absorbable Ethibond. As expected, the properties of the non-absorbable Ethibond did not differ over time. Unexpectedly, also Maxon and PDS maintained their elastic properties in spite of their proceeding degradation and loss of tensile strength.
Thus, even after considerable loss of failure strength, the relative elasticity of these materials remained intact and the suture could still be expected to adequately support transient tissue loads. However, while PDS may be considered useful to bear clinically relevant loads on the tendon, ligaments, or bone, Maxon and Vicryl may be rather considered where mechanically less challenged adaptation of tissue is performed such as in closure of peritendineum, side-to-side repairs of fascia, and similar situations.
In summary, this is the first study assessing the properties of large-diameter degradable sutures during a time period relevant for orthopedic applications. The non-absorbable Ethibond and surprisingly the absorbable Maxon and PDS revealed relatively constant values despite the process of degradation.
The choice of an appropriate suture material should consider the expected duty loads in context of tissue healing time. The data we present provides some guidance to the orthopedic surgeon in better predicting the long-term performance of suture materials used everyday in surgical practice.
Rotator cuff repair failure in vivo: a radiostereometric measurement study. J Shoulder Elbow Surg. Article PubMed Google Scholar. Experimental rotator cuff repair. A preliminary study. J Bone Joint Surg Am.
Chu CC, Moncrief G. An in vitro evaluation of the stability of mechanical properties of surgical suture materials in various pH conditions. Annals of surgery. Biodegradation of absorbable sutures in body fluids and pH buffers.
Eur Surg Res. The pH dependence of monofilament sutures on hydrolytic degradation. J Biomed Mater Res. Monocryl has a low tissue reactivity, maintains high tensile strength, and has a half-life of 7 to 14 days.
Polydioxanone sutures absorb by simple hydrolytic mechanism and absorption is predictable. Does Prolene suture dissolve? Sutures can be either absorbable or nonabsorbable.
Absorbable sutures are intended to be broken down by the body over time and eventually dissolve completely. Non-absorbable sutures can be made from nylon, polypropylene prolene , or silk. What does PDS suture mean? Polydioxanone PDS Description. Absorbable biological suture material. Plain is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. Which suture absorbs the fastest? Fast absorbing surgical gut suture is a strand of collagenous material prepared from the submucosal layers of the small intestine of healthy sheep, or from the serosal layers of the small intestine of healthy cattle.
Fast absorbing surgical gut sutures are intended for dermal skin suturing only. What kind of stitches are clear?
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