Editing Suture Materials

== Classification ==

* '''Based on'''
*# '''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'''
** '''Synthetic'''
*** '''Advantages'''
**** '''Less tissue reaction'''

== 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 ==

* '''Monofilament'''
** '''Nylon'''
*** Natural
** '''Prolene'''
*** Synthetic
* '''Braided'''
** '''Silk'''
*** Natural

== 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'''

== Needles ==

* Characteristics to consider
**Point
***Taper vs. cutting
**Circle
***1/2
***3/8
***5/8
**Length
***26 mm
***36 mm
***40 mm
*Common needles
**CT-1 (Ethicon): taper, 1/2 circle, 36mm
***Similar needle in Covidien: GS-21
**SH: taper, 1/2 circle, 26mm
***Similar needle in Covidien: V-20
**RB-1: taper, 1/2 circle, 17mm
***Similar needle in Covidien: CV-23
**UR-6: taper, 5/8 circle, 26mm
*Covidien
** Urology needles are available as taper point and 5/8 circle, with lengths of 27 mm (GU-46 and HGU-46), 37 mm (GU-45) and 40 mm (GU-44).[https://www.medtronic.com/covidien/en-gb/products/wound-closure/suture-needles.html#]

== Techniques ==

* [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966262/ Knotting Looped Polydiaxone During Abdominal Wound Closure]

== 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