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2.1 Suture Materials
ОглавлениеSutures are classified as absorbable or nonabsorbable, and monofilament or multifilament (Table 2.1). Absorbable sutures are desirable in gastrointestinal surgery since they eventually are degraded and removed by the body over days to months. Nonabsorbable sutures do not lose significant strength over 60 days, and remain in the tissues to some degree for years. Monofilament sutures are composed of a single smooth strand, whereas multifilament sutures are braided or woven from multiple strands.
Suture is selected for a specific digestive organ wound repair considering the physical characteristics of the suture material (tensile strength and knot security, absorption rate, surface qualities, capillarity, tissue reactivity), and the environment and healing rate of the tissue involved in the repair. As a rule, more pliable and smaller diameter sutures have favorable handling properties in gastrointestinal surgery compared to larger, stiffer suture materials.
Table 2.1 Characteristics of suture materials used in digestive system procedures.
Absorbable Suture | Nonabsorbable Suture | Trade Name | Type | Degradation Process | Foreign Body Response | Tensile Strength Retention (%) | Relative Knot Security | Mass Absorption Time (days) | Comments |
Chromic Catgut | Surgical gut; chromic gut | Rapid to Intermediate absorbable multifilament | Phagocytosis and proteolytic enzymes | Moderate | Unpredictable | Fair | Variable; 45–60 d or longer | Degradation and tissue reactivity related to where implanted; knots imbibe fluid and unravel if knot ears are cut short | |
Polyglactin 910 | Vicryl Rapide | Rapid absorbable multifilament | Hydrolysis | Mild | 50% after 5 d; 0% after 14 d | Fair to good | 42 | Irradiated to aid in dissolving | |
Vicryl, Coated Vicryl Plus | Intermediate absorbable multifilament | Hydrolysis | Mild | 75% after 14 d; 50% after 21 d | Fair to good | 56–70 | Plus designates triclosan (antibacterial) impregnated | ||
Lactomer | Polysorb (coated) | Intermediate absorbable multifilament | Hydrolysis | Mild | 80% after 14 d; 30% after 21 d | Fair to good | 56–70 | Improvements in braid construction and coating reduce drag and improve knot security | |
Velosorb (coated) | Rapid absorbable multifilament | Hydrolysis | Mild | 60% at 5 d; 0% at 14 d | Fair to good | 40–50 | Irradiated to aid in dissolving; similar to Vicryl Rapide | ||
Polyglycolic Acid | Dexon S (uncoated), Dexon II (coated) | Intermediate absorbable multifilament | Hydrolysis | Mild | 65% after 14 d; 35% after 21 d | Fair to good | 60–90 | Coated Dexon II helps reduce drag, but decreases knot security | |
Polyglytone 6211 | Caprosyn | Rapid to intermediate absorbable monofilament | Hydrolysis | Minimal | 60% after 5 d; 20–30% after 10 d | Fair | 56 | Knots have been known to untie spontaneously when incubated in serum; supple easy to handle for monofilament; fastest mass absorption of absorbable monofilaments | |
Polygliocaprone 25 | Monocryl | Rapid to intermediate absorbable monofilament | Hydrolysis | Minimal | 50–60% after 7 d; 20–30% after 14 d; 0% after 21 d | Good | 91–119 | Supple easy to handle for monofilament. | |
Polyglycolic Acid/Polycaprolactone | Quill Monoderm | Intermediate absorbable monofilament barbed | Hydrolysis | Slight | 42–76% at 7 d; 36–52% at 14 d | N/A | 90–120 | Uni‐ and bidirectional barbed suture; choose one size larger due to strength loss from barbs. Slightly higher tissue reaction than V‐Loc 90. | |
Stratafix PGA‐PCL Plus (barbed) | Rapid to intermediate absorbable monofilament barbed | Hydrolysis | Minimal | 50–60% after 7 d; 20–30% after 14 d; 0% after 21 d | N/A | 90–120 | Stratafix Monocryl comes with spiral barbs; uni‐ or bidirectional. Plus – antibacterial | ||
Glycomer 631 | Biosyn | Intermediate absorbable monofilament | Hydrolysis | Minimal | 75% after 14 d; 40% after 21 d | Average | 110 | Knots occasionally untie spontaneously | |
V‐Loc 90 | Intermediate absorbable monofilament barbed | Hydrolysis | Minimal | 90% at 7 d; 75% at 14 d | N/A | 90 | Unidirectional barbed suture; equivalent to strength of suture one size smaller – choose size as you would conventional suture | ||
Polyglyconate | Maxon | Prolonged absorbable monofilament | Hydrolysis | Minimal | 81% after 14 d; 59% after 28 d; 30% after 42 d | Good | 180 | Similar to PDS II; tends to have slightly more memory in larger sizes | |
Polydioxanone | PDS II; PDS Plus | Prolonged absorbable monofilament | Hydrolysis | Minimal | 74% after 14 d; 58% after 28 d; 41% after 42 d | Good | 180 | Plus designates triclosan (antibacterial) impregnated | |
V‐Loc 180 | Prolonged absorbable monofilament barbed | Hydrolysis | Negligible | 80% at 7 d; 75% at 14 d; 65% at 21 d | N/A | 180 | Unidirectional barbed suture; equivalent to strength of suture one size smaller‐choose size as you would conventional suture. | ||
Stratafix PDO, PDO Plus | Prolonged absorbable monofilament barbed | Hydrolysis | Negligible | 80% at 7 d; 75% at 14 d; 65% at 21 d | N/A | 120–180 | Stratafix comes in uni‐ and bidirectional strands with symmetrical or spiral barbs. Symmetrical unidirectional barbed sutures are recommended for high tension repairs. PDS plus is antibacterial | ||
Quill PDO | Prolonged absorbable monofilament barbed | Hydrolysis | Negligible | 67–80% at 14 d; 50–80% at 28 d | N/A | 180 | Uni‐ and bidirectional barbed suture; choose one size larger due to strength loss from barbs | ||
Polyamide | Ethilon; Dermalon; Surgilon | Nonabsorbable monofilament | N/A | Minimal | 15–20% loss in 365 d; retains 80% indefinitely | Fair | N/A | Slowly loses strength over years by process of hydrolysis | |
Nurolon | Nonabsorbable multifilament | N/A | Minimal | 15–20% loss in 365 d; retains 80% indefinitely | Fair | N/A | Slowly loses strength over years by process of hydrolysis | ||
Quill Nylon | Nonabsorbable monofilament barbed | N/A | Minimal | Similar to conventional nylon | N/A | N/A | Similar to conventional nylon | ||
Polybutester | Novafil | Nonabsorbable monofilament | N/A | Negligible | N/A | Good | N/A | Handles well for monofilament; stretchy | |
V‐Loc PBT | Nonabsorbable monofilament barbed | N/A | Negligible | N/A | N/A | N/A | Unidirectional barbed suture; permanent soft tissue approximation; equivalent to strength of suture one size smaller – choose size as you would conventional suture | ||
Polypropylene | Prolene; Surgipro; Surgipro II | Nonabsorbable monofilament | N/A | Negligible | N/A | Good | N/A | Does not lose appreciable strength over long periods of time; one of most inert suture besides steel | |
Quill Polypropylene | Nonabsorbable monofilament barbed | N/A | Negligible | N/A | N/A | N/A | Uni‐ and bidirectional barbed suture; choose one size larger due to strength loss from barbs | ||
Stratafix Polypropylene | Nonabsorbable monofilament barbed | N/A | Negligible | N/A | N/A | N/A | Uni‐ or bidirectional spiral barb configuration. Similar characteristics otherwise with conventional polypropylene | ||
Hexafluoropropylene VDF | Pronova | Nonabsorbable monofilament | N/A | Negligible | N/A | Good to very good | N/A | Good alternative to polypropylene; better handling and strength | |
Stainless Steel | Surgical Stainless Steel (mono); Steel | Nonabsorbable monofilament | N/A | Negligible | N/A | Excellent | N/A | Difficult to handle; may tend to cut through soft tissues | |
Surgical Stainless Steel (Multi); Flexon | Nonabsorbable multifilament | N/A | Negligible | N/A | Excellent | N/A | Multifilament improves handling; excellent knot security | ||
Silk | Permahand; Sofsilk | Nonabsorbable multifilament | Proteolytic enzymes | Moderate to severe | 70% after 14 d; 50% after 30 d | Fair | Gradual encapsulation by fibrous tissue | Considered one of the best handling sutures available | |
Polyester | Mersilene (uncoated); Ethibond Excel (coated); Ticron; Surgidac | Nonabsorbable multifilament | N/A | Mild to moderate | N/A | Fair | Gradual encapsulation by fibrous tissue | Strong, relatively good handling; knot security is a concern |
NA = Not Applicable.
Chu et al. (1997) and Capperauld (1989).
http://www.medtronic.com/covidien/en‐us/products/wound‐closure.html.