Editing Suture Materials (section)

== 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 absorbable sutures are absorbed by nonenzymatic hydrolysis in a predictable manner 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 absorbable 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'''
** '''4-0 to 6-0 suture'''