OTHER: SUTURE MATERIALS
Classification
- Absorbable vs. non-absorbable
- Braided (multifilament) vs. monofilament
- Synthetic vs. natural
- Absorbable vs. non-absorbable
- Non-absorbable
- Advantage
- Longer mechanical support
- Disadvantage
- Nidus for stone formation in urinary tract
- Braided (multifilament) vs. monofilament
- Monofilament
- Advantages
- Less tissue dragging and tearing
- Less tissue reaction
- Reduces spread of wound infection since does not provide capillary wicking of fluids
- Synthetic vs. natural
Absorbable
- Monofilament
- Catgut
- Natural
- Majority based on type I collagen
- Extracted from the intestines of sheep or goats
- Two types: plain vs. chromic
- Chromic
- Treated with chrome salts (brown colour) which slows absorption time and reduces tissue reaction
- Completely absorbed within ≈70-90 days
- Time to 50% breaking strength retention: 3-4 weeks§
- Advantages
- High elasticity
- Good tensile strength
- Plain catgut: 7 days
- Chromic catgut: 14 days
- Disadvantages
- Poor knot security
- Tissue reaction (due to foreign protein nature of catgut suture)
- Plain catgut has more tissue reaction than chromic catgut
- Monocryl
- Also known as poliglecaprone
- Synthetic
- Completely absorbed within ≈90-120 days§
- Identical knot performance compared with Vicryl, similar performance to PDS, and lesser performance compared with Maxon
- High initial breaking strength, being superior to chronic gut, Vicryl, and PDS
- Time to 50% breaking strength retention: 1 week§
- Advantages§
- Pliability, minimal force required to bend
- Less out-of-package memory than maxon and PDS
- Maxon
- Also known as polyglyconate
- Synthetic
- Completely absorbed within ≈100 days
- Biosyn
(Covidien)
- Synthetic
- Completely absorbed within ≈90-110 days§
- PDS
(Ethicon)
- Also known as polydioxanone
- Synthetic
- Completely absorbed within ≈200 days
- Enhanced version (PDS II) has improved flexibility and handling characteristics
- Braided
- Vicryl
(Ethicon)/Polysorb
(Covidien)
- Also known as polyglactin
- Synthetic
- Completely absorbed within ≈60 days
- Time to 50% breaking strength retention: 3 weeks§
- Dexon
(Covidien)
- Also known as polyglycolic acid
Non-absorbable
Clinical implications
- Closure of urinary tract wounds§
- Wounds of the urinary bladder wall regain strength equal to unwounded bladder wall within 21 days, based on animal studies§
- Wounds of stomach and colon do not achieve more than 70 per cent of unwounded tissue strength after 120 days§
- Braded, synthetic absorbale sutures (polyglactin 910 (Vicryl) and polyglycolic acid (Dexon)) should be used in the absence of infection
- Braded, synthetic absorbale sutures are absorbed by nonenzymatic hydrolysis in a predicatable mannder with limited inflammatory response while gut sutures have an unpredictable absorption rate by enzymatic degradation and elicit an exaggerated inflammatory response
- In the presence of infection, use absorbable natural fiber suture e.g. Catgut
- Proteus species, accelerates the degradation of absorbale synthetic sutures to a greater degree than Catgut suture
- Nonabsorbable sutures or staples should not be used in the urinary tract because predictably promote urolithiasis.
- Bladder closure§
- 2-layered closure
- Close mucosal layers with 3-0 Vicryl in running manner
- Close detrusor/serosal layers with 2-0 Vicryl in running manner
- Ureteroureterostomy
References
- Rose, Jessica, and Faiz Tuma."Sutures And Needles." StatPearls [Internet] (2020).
- Chu, C. C. Biotextiles as medical implants: 11. Materials for absorbable and nonabsorbable surgical sutures. Elsevier Inc. Chapters, 2013.
- Edlich, Richard F., George T. Rodeheaver, and John G. Thacker. "Considerations in the choice of sutures for wound closure of the genitourinary tract." The Journal of urology 137.3 (1987): 373-379.
