Catgut sutures when they dissolve. How long does it take for threads to dissolve after surgery?

In some cases, for example, during surgery, as well as after childbirth, absorbable sutures are required. For this, a special material is used. There are many types of absorbable threads. The healing time of such wounds depends on many factors. So how long do self-absorbable sutures absorb?

The main types of seams

To answer this question, it is necessary to clarify what main types of seams exist. As a rule, this is:

1. Internal. Similar seams are superimposed on injuries resulting from mechanical stress. Certain types of tissues are used to connect tissues at the rupture site. Such self-absorbable sutures heal quite quickly. Often they are applied to women after childbirth on the cervix. In this case, anesthesia is not required, since this part of the reproductive organ is devoid of sensitivity.
2. Outdoor. They can also be applied using absorbable material. After childbirth, such sutures are made at rupture or during dissection of the perineum, as well as after operations. If conventional material is used, then its removal is required 5-7 days after surgery.

It is worth considering that self-absorbable sutures can heal after a few weeks. It all depends on the type of material and its composition.

What are absorbable sutures

Self-absorbable sutures are almost always applied. It is extremely rare for wound healing to use surgical material that is resistant to hydrolysis. Absorbable sutures are those that lose their strength as early as 60 days. There is a dissolution of the threads as a result of exposure to:

1. Enzymes that are present in the tissues of the human body. In other words, these are proteins that control and accelerate the course of chemical reactions.
2. Water. This chemical reaction is called hydrolysis. In this case, the threads are destroyed under the influence of water, which is present in the human body.

Synthetic braided polyglycolide thread "MedPGA"

Analogues of such surgical material are "Safil", "Polysorb", "Vikril".

Self-absorbable operations or after childbirth can be superimposed using the MedPHA thread. This surgical material is made on the basis of polyhydroxyacetic acid. These threads are coated with an absorbable polymer. This is required to reduce wicking and capillarity, as well as to reduce the sawing effect that occurs when the material is passed through tissues.

How long does it take for the MedPGA thread to dissolve?

Self-absorbable sutures applied with the MedPGA thread undergo hydrolytic degradation, which is strictly controlled. It should be noted that such material is quite durable. After 18 days, the threads retain up to 50% of their strength properties.

Complete resorption of the surgical material occurs only after 60-90 days. At the same time, the reaction of body tissues to the MedPHA threads is insignificant.

It should be noted that such surgical material is widely used for suturing all tissues, with the exception of those that are under tension, and also do not heal for a long time. Most often, MedPGA threads are used in thoracic and abdominal surgery, gynecology, urology, plastic surgery and orthopedics. However, it is not used on nervous and cardiovascular tissues.

Synthetic braided polyglycolide thread "MedPGA-R"

Analogues of such surgical material are "Safil Quick", "Vikril Rapid".

"MedPGA-R" is a synthetic thread made on the basis of polyglyclactin-910. Such surgical material is covered with a special absorbable polymer. This reduces friction as the thread passes through the tissues of the body, and also reduces wicking and capillarity. Thanks to this surgical material, self-absorbable sutures can be applied.

How long does it take for MedPGA-R threads to dissolve?

"MedPGA-R" - a material that lends itself to hydrolytic decomposition. Such threads are quite strong. After five days, 50% of their strength properties are retained. Complete resorption occurs only for 40-50 days. It should be noted that the reaction of tissues to the MedPGA-R surgical material is insignificant. In addition, the threads do not cause allergies.

This material is used for suturing mucous membranes, skin, soft tissues, as well as in situations where short-term wound support is needed. However, there are exceptions. Such threads are not used on nervous and cardiovascular tissues.

Synthetic braided polyglycolide thread "MedPGA-910"

Analogues of such surgical material are "Safil", "Polysorb", "Vikril".

"MedPGA-910" is an absorbable thread made on the basis of polygliglactin-910. The surgical material is also treated with a special coating, which reduces the "sawing" effect when the material passes through the tissues, as well as to reduce capillarity and wicking.

Terms of resorption "MedPGA-910"

So, when do self-absorbable sutures applied with the use of MedPGA-910 surgical material dissolve? Such threads have a high rate of strength. However, they also undergo hydrolytic degradation. After 18 days, the surgical material can retain up to 75% of the strength properties, after 21 days - up to 50%, after 30 days - up to 25%, and after 70 days, the threads are completely resorbed.

This product is used for suturing soft tissues that are not under tension, as well as those that heal quickly, in plastic, thoracic and abdominal surgery, gynecology, urology and orthopedics. Do not use "MedPGA-910" when suturing nervous and cardiovascular tissues.

Monofilament "PDO"

There are not so many analogues of such surgical material. This is Biosyn, as well as PDS II. Such threads are characterized by a high rate of biological inertness, are non-wicking and non-capillary, hydrophobic, do not injure tissues when passing through them, are elastic, strong enough, fit well and hold the knot.

How long does it take for monofilaments to dissolve?

Monofilaments "PDO" are amenable to hydrolysis. As a result of this process, dihydroxyethoxyacetic acid is formed, which is completely excreted from the body. 2 weeks after suturing, the surgical material retains up to 75% strength. Complete dissolution of threads occurs within 180-210 days.

As for the field of application, the PDO surgical material is used for suturing and connecting soft tissues of any type, including for suturing the cardiovascular tissues of the child's body, which are subject to further growth. However, there are also exceptions. Monofilaments are not suitable for suturing tissues where wound support is required for up to 6 weeks, as well as those that are subjected to heavy loads. Do not use when installing implants, artificial heart valves, as well as synthetic vascular prostheses.

So how long will the stitches dissolve?

Next, we will consider everything regarding what are self-absorbable sutures after childbirth: when they dissolve, whether they require care. Do not forget that many factors affect the timing of wound healing and the complete disappearance of threads. First of all, you need to know what raw materials the surgical material is made of. In most cases, the threads begin to dissolve 7-14 days after suturing. To speed up the process, after the wound has healed, the health worker may remove the nodules. To determine the timing of resorption of threads, you should check with your doctor:

1. What stitches were placed.
2. What material were the threads made from?
3. Approximate timing of the dissolution of the suture material.

In conclusion

Self-absorbable sutures are often used for suturing surgical wounds that are located in deep tissue layers, as well as on the surface of the skin. For example, organ transplants.

The same surgical material is used for and ruptures obtained during childbirth. In the meantime, a lot of research has been done. Their results showed that a suture made from polyglycolic acid completely disappeared after only four months, and a material based on polyglactin after three. At the same time, self-absorbable sutures will hold the edges of the wound until it is completely healed, and then gradually begin to collapse. If the threads persist for a long time and cause discomfort, then you should seek help from a surgeon or your doctor.

During surgery, absorbable sutures are increasingly being applied - the so-called threads, which perform a fixing function: they hold damaged tissues and promote their healing.How long does it take to dissolve such threads , depends on several factors - the place of their application, the individual characteristics of the body, but the main one is the material for making the base of the threads.

This is the name of the retaining threads, which lose their fixing properties for up to 4 months. In surgical practice, the following types of absorbable sutures are most often used:

• Catgut is an organic type of thread, the material for the manufacture of which is cow intestines. At the same time, it is the longest absorbable - catgut "keeps" up to 4 months;
• Lavsan - synthetic threads based on polyesters. They are used when long-term fixation is not required, since the material is rapidly losing its holding power;
• Vicryl is another representative of synthetic sutures that are actively used in medicine, including cosmetics.

In addition to those mentioned, there are many other types of materials used. Their choice depends on the type of intervention performed and the mobility of the tissues in the area of ​​the operation, so only a doctor can individually select the threads, which subsequently will not leave scars, but will dissolve in a short time.

The main factors contributing to the self-destruction of such threads in human tissues are called:

• Chemical reactions of the body based on the interaction of proteins;
• Chemical reactions of a material with water contained in the human body.

It is they who provoke the dissolution of postoperative threads, which are used to tighten surgical tissue incisions for a short time.

When to use absorbable sutures

This type of medical materials is used for suturing surgical wounds: such manipulations are carried out both on the surface of the skin, during cosmetic operations, and in deep layers of tissues, for example, during transplantation of internal organs.

The main function of such sutures is to maintain the internal tissues in a stable state until they fuse and begin to function without outside support.

Absorbable sutures are also advisable in cases where the patient will not be able to return to the surgeon to remove the superimposed staples, clamps or sutures made of durable materials.

The most common use of absorbable sutures in gynecology is to close the perineum, tears in the vagina or cervix during natural childbirth. Studies have shown that in the postpartum period, the threads removed themselves within 2-4 months.

How long does it take for threads to dissolve after surgery?

To understand after how many days the threads dissolve, you must first ask your surgeon what material was used for suturing. The doctor will not only clarify the information you are interested in, but also advise how long it will take for the complete resorption of the sutures. Only a specialist can competently evaluate this process, taking into account the individual characteristics of the patient.

But in general, focus on, how long does it take to dissolvethreads, you need to look like the threads used during the operation:

• Catgut begins to lose its fixing properties after a month, while the threads finally dissolve only by the end of the 4th month of wound healing;
• Lavsan is often used in cosmetology, since the material begins to break down as early as 10-12 days, but this process can take up to 1.5 months;
• Vicryl has an average degree of resorption: the threads lose their strength after 2-3 months.

At the same time, it is worth making an allowance for the correct care of the postoperative wound according to the scheme recommended by the observing surgeon. If it is not properly processed and the rules of personal hygiene are neglected, healing may be delayed, and the process of resorption of the sutures will be aggravated.

How to care for absorbable sutures

Having dealt with the issue,how long does it take for threads to dissolve, it is important to understand how to properly care for the suture after the operation, so that the healing proceeds safely, the threads are safely rejected, while as quickly as possible, and there are no scars left at the intervention site.

Pay attention to the following most important rules for the care of postoperative sutures:

1. The most important point is the sterility of all manipulations. Before treating a wound, be sure to wash your hands, and thoroughly disinfect all tools.
2. Depending on the nature of the sutured wound, it must be treated with an antiseptic - brilliant green, Fukortsin, potassium permanganate solution, hydrogen peroxide, medical alcohol. What exactly to use, it is better to check with the observing surgeon. You may have to combine medications and use with anti-inflammatory ointments.
3. During water procedures, eliminate friction, the wound can only be washed with warm water or a decoction of herbs.
4. If we talk about postpartum stitches, then it is imperative to observe intimate hygiene - this will prevent complications.

So, in order to find out how long it will take for the successful resorption of superimposed sutures after surgery, you first need to find out the material from which they are made. It is also worth taking into account the individual characteristics of the body: if you have a tendency to long-term healing wounds, then be prepared for the fact that the complete resorption of postoperative threads can take up to six months, especially if organic materials were used during wound suturing.

Plastic surgery is an art form in which a doctor, wielding a scalpel, like a sculptor, carves out new features for his patient. The work of a plastic surgeon is a very delicate matter, in which every, even the most seemingly insignificant detail affects the final result. In plastic surgery, as in any other branch of surgery, the stitching of wounds occurs using surgical threads. The doctor should approach the issue of choosing a suture material with all seriousness, since correctly selected surgical threads are the final touch in the entire process of surgical intervention.

How the quality of the suture material affects the result of the operation

Suture material in plastic surgery is selected in accordance with each type of surgical intervention. The quality of suture materials is one of the main factors affecting the healing process of a postoperative wound. All patients in the postoperative period are looking forward to the day of suture removal, because only then it is possible to consider and evaluate the result of the operation in more detail. Suture material in surgery is used not only to close skin wounds, but also to stitch other tissues of the body, therefore, when choosing surgical threads, one should take into account what will happen to the tissues that are stitched in the future.

Suture material:

• requirements for suture materials;
• basic properties of absorbable suture materials;
• when it is appropriate to use a non-absorbable suture.

Requirements for suture materials

Today, plastic surgery places high demands on the quality of suture materials. The main requirements for surgical threads are as follows:

• suture materials must be biocompatible - that is, the threads must not produce a toxic, teratogenic and allergic effect on the patient's body;
• biodegradation - the suture material must be able to disintegrate and be excreted from the patient's body, while the rate of this process should not exceed the rate of scar formation;
• the threads must be atraumatic - this means that the surgical threads must have sufficient flexibility and elasticity, connect well with the needle and not produce a "spreading" effect;
• suture materials must be strong - the strength of the thread must guarantee the preservation of the suture until the complete formation of the postoperative scar.

Basic properties of absorbable suture materials

Absorbable sutures are the main suture material in modern plastic surgery, since they do not require removal and dissolve in the wound on their own. The main absorbable suture materials include:

• catgut is an absorbable suture material that completely dissolves within 60-90 days after surgery. Most relevant when suturing the back surface of the auricle after otoplasty, or when closing wounds of the scalp;
• Vicryl and Dexon are coated polyfilament surgical sutures. Such threads are stronger and less reactive than catgut. Vicryl completely resolves 70 days after surgery, and Dexon - 90 days;
• polysorb is an absorbable coated suture material. Its density is even higher than the density of Vicryl and Dexon, while the complete resorption of the thread occurs 70 days after surgery;
• monocryl is an elastic absorbable suture material that practically does not cause an inflammatory reaction and completely dissolves no earlier than 90-120 days after surgery.

When is it appropriate to use a non-absorbable suture?

Non-absorbable suture materials differ from absorbable ones in much higher strength, better manipulation properties, less reactogenicity, while such materials are not capable of disintegrating and being excreted from the patient's body. Such suture materials are most often used for fixing implants and cartilage structures, as well as for suspending soft tissues of the body. These include:

• polyamides - have high strength and flexibility, but cause a fairly pronounced reaction from the tissues;
• pyloesters are more inert, but less elastic than polyamides;
• polyolefins - have high inertness, elasticity and strength, guarantee the reliability of the surgical site;
• metal clips - often used in plastic surgery when closing wounds on the scalp. Their main advantage is the ease of application and removal, as well as the formation of a reliable and fast connection of damaged tissues.

History of occurrence

Suture materials have been used for several millennia. The first mention of suture material was found 2000 BC in a Chinese treatise on medicine. Mention was made of intestinal and skin sutures using threads of plant origin. In ancient times, various materials were used for seams: horse hair, cotton, skin patches, tree fibers and animal tendons.

In 175 BC, Galen first described catgut (ketgat - cat gut). Interestingly, the literal translation of this word from English is “cat’s gut”. In the middle of the 19th century, Joseph Lister described methods for sterilizing catgut threads, and since then they have entered into widespread practice as the only material. Another modern suture material is silk. Its use in surgery was first described in 1050 AD. In 1924, in Germany, Hermann and Hochl first obtained polyvinyl alcohol, which is considered the first synthetic suture material. In 1927 in America, Corotes repeated the discovery and called the resulting material nylon. In the 1930s, two more synthetic suture materials were created in Western laboratories: kapron (polyamide) and lavsan (polyester). Already in the late 1930s and 1940s, these materials began to be widely used in surgery.
In 1956, a fundamentally new material appeared: polypropylene.
In 1971, synthetic absorbable sutures were first used.

Modern surgical suture material

Surgical suture is a foreign thread used to connect tissues to form a scar. In 1965, A. Shchupinsky formulated the requirements for modern surgical suture material:

1. Ease of sterilization
2. inertia
3. The strength of the thread should exceed the strength of the wound at all stages of its healing.
4. Node Reliability
5. resistance to infection
6. Absorbability
7. Comfortable in the hand, softness, plasticity, good handling properties, no thread memory
8. Applicability for any operation
9. Lack of electronic activity
10. No allergenic properties
11. The tensile strength in the knot is not lower than the strength of the thread itself
12. Low cost

Classification of suture materials

According to the structure of the thread

1. Monofilament, or single fiber- this is a thread consisting of a single solid fiber. It has a smooth flat surface. Monofilament
2. Shedding, or multifilament(Polyfilamentous), which happens:

• twisted
• wicker

These yarns can be coated or uncoated. Uncoated multifilament threads have a sawing effect. When such a thread is pulled through the fabric, due to its rough, uneven surface, it cuts through and injures the fabric. This results in more tissue damage and more bleeding at the puncture site. Such threads are difficult to pull through the fabric. To avoid this effect, many polyfilaments are coated with a special coating that gives the thread a smooth surface. Such threads are called combined. Multifilament threads have a so-called wick effect. This is when microvoids remain between the fibers of a braided or twisted thread, which are filled with tissue fluid when such a thread is in the wound. If this wound is infected, then microbes can move through these micropores to a healthy, uninfected part of the tissue, causing an inflammatory or suppurative process there. Having considered all the above points, we can conclude that mono- and polyfilaments have both positive and negative properties:

1. Strength - braided threads are more tensile; they also retain more strength in the knot. The monofilament becomes less strong in the knot area. In endoscopic operations, multifilament sutures are used. This is due to the fact that in endosurgery, mainly intracorporeal methods of knotting are used, which involves tying the thread with the help of tools. At the same time, monofilaments in the place of compression by the tool may lose strength and break.
2. Manipulation properties - the manipulation properties of threads include: elasticity and flexibility. Elasticity is one of the main parameters of the thread. It is more difficult for the surgeon to manipulate rigid threads, which leads to more tissue damage. Again, when working in a small operating field, a stiff thread, having increased memory, gathers in a ball in the wound, creating additional difficulties for the surgeon. Multifilament thread is much softer, more ductile, has less memory. The braided thread is knitted with fewer knots. When pulled through the fabric, the monofilament passes more easily; when removing it from a wound, for example, an intradermal suture, it does not adhere to the tissues and is easily removed. The braided thread has time to grow to the fabric in 5-6 days, so it is very difficult to remove it.
3. The strength of the knot is also related to the surface properties of the threads. As a general rule, the smoother the surface of the thread, the weaker the knot on it. Therefore, more knots are knitted on monofilament threads. By the way, one of the points of modern requirements for suture material is the minimum number of knots necessary for its reliability. After all, any extra node is a foreign material. The fewer nodes, the less the reaction of tissue inflammation.
4. Biocompatibility or inertness is the ability of a thread to cause tissue irritation. Monofilaments have less irritating effect. All things being equal, a multifilament thread will cause a greater tissue inflammatory response than a monofilament thread.
5. The wick effect is the ability of the thread to absorb the contents of the wound. As we already know, multifilament threads have this effect, while monofilament threads do not. Therefore, being in an infected wound, monofilaments do not support the suppuration process.

Suture properties

According to the ability to biodegrade (resorption in the body), the suture material is divided into:

• absorbable;
• conditionally absorbable;
• non-absorbable.

To absorbable materials include:

• catguts;
• synthetic absorbable threads.

Simple catgut and chrome-plated catgut are a material of natural origin from the serous tissue of cattle or small cattle. Absorbable threads have two characteristics in terms of resorption time. It:

1. Biological strength or tissue support - the period during which the absorbable thread is in the human body retains another 10-20% of its original strength.
2. The term of complete resorption is the time it takes for the absorbable thread to completely dissolve in the body.

The biological strength of a simple catgut is 7-10 days; chrome plated 15-20 days. The term of complete resorption in a simple catgut is 50-70 days, and in a chrome-plated one it is 90-100 days.

These terms are very arbitrary, since the resorption of catgut in the human body occurs through its splitting by cellular proteolytic enzymes. Therefore, the rate of dissolution of catgut will depend on the condition of the person, as well as on the state of health of the animal from which the catgut thread was made. Often there are cases when the catgut did not resolve even after six months.

Absorbable materials of artificial origin include threads made of polyglycolic acid, polydiaxonone and polyglycapron. They differ in structure: monofilament and shedding, in terms of tissue containment and terms of complete resorption.

All firms producing surgical suture material make it from the same polymers. Therefore, as the basis for the classification of synthetic absorbable threads, we will take their terms of tissue containment and the terms of complete resorption:

• Synthetic absorbable sutures with a short resorption time. These are braided threads made of polyglycolic acid or polyglycolide.

The biological strength of these threads, like that of a simple catgut, is 7-10 days, the period of complete resorption is 40-45 days. These threads are used in general surgery, pediatric surgery, plastic surgery, urology and in any other surgery where 7-10 days are enough for tissues to form a scar. The advantage of these threads is their short resorption time of 40-45 days. This is a short enough time that these threads do not form urinary or gallstones, they are very good for an absorbable intradermal cosmetic suture, the patient does not need to return to the surgeon to remove the threads.

• Synthetic absorbable sutures with an average resorption time: They can be braided and monofilament.

This group of threads is more often than others used in surgery, since their tissue support period is 21-28 days - this is the period for which a scar forms in most human tissues. Further, the need for threads disappears and after 60-90 days they dissolve, leaving no traces in the body. These threads are used in various areas of surgery. Polyglycapron monofilaments also belong to the group of the average resorption period. The period of tissue containment for these threads is 18-21 days, complete resorption occurs after 90-120 days. These threads can be used in any surgery. Their disadvantage is that they have worse handling properties than braided absorbable threads - they need to be knitted with more knots.

• The third group of absorbable synthetic threads are threads with a long resorption time from polydiaxanone.

Their tissue support period is about 40-50 days. Complete resorption after 180-210 days. These threads are used in general, thoracic surgery, in traumatology, in maxillofacial and oncosurgery, as well as in any other surgery where an absorbable thread is needed to support tissues with a long scar formation period: these are cartilaginous tissue, aponeuroses, fascia, tendons. Recently, throughout the world, catgut has been replaced by synthetic absorbable threads. Let's consider several reasons why this happens: catgut thread is the most reactogenic of all threads currently used - it is the only thread to which an anaphylactic shock reaction has been described. The use of catgut threads can be considered an operation for transplanting foreign tissue, since it is made from a foreign protein. Experimental studies have shown that when suturing a clean wound with catgut, it is enough to introduce 100 microbial bodies of staphylococcus into it to cause suppuration (usually one hundred thousand are needed normally). Catgut thread, even in the absence of microbes, can cause aseptic tissue necrosis. Previously, it was said about the unpredictable terms of the loss of strength of catgut resorption, moreover, if we compare threads of the same diameter, the strength of catgut is less than that of synthetic threads. Catgut, being in the wound, causes its irritation, inflammation, which leads to its longer healing. Tissue sutured with synthetic absorbable suture heals faster. It has long been noticed that as soon as the surgical department switches from catgut to synthetic thread, the percentage of postoperative complications decreases. All of the above suggests that in modern surgery there are no indications for the use of catgut. At the same time, some surgeons continue to use it and consider catgut to be a satisfactory suture material. First of all, this is due to the habit of surgeons, the lack of experience in the use of synthetic absorbable threads. To the group conditionally absorbable threads we refer to:

• polyamides or capron;
• polyurethanes.

Silk for its physical properties is considered the gold standard in surgery. It is soft, plastic, durable, allows you to knit two knots. However, due to the fact that it belongs to materials of natural origin, its chemical properties are comparable only to catgut and the inflammation reaction to silk is only slightly less pronounced than to catgut. Silk also causes aseptic inflammation, up to the formation of necrosis. When using a silk thread in the experiment, 10 microbial bodies of staphylococcus were enough to cause suppuration of the wound. Silk has pronounced sorption and wick properties, therefore it can serve as a conductor and reservoir of microbes in the wound. Being in the human body, silk dissolves within 6-12 months, which makes it impossible to use it for prosthetics, and therefore it is recommended to replace silk threads with another material. A group of polyamides (kaprons) is absorbed in the body within 2-5 years. Polyamides are historically the first synthetic suture materials chemically unsuitable for surgical suture. These threads are the most reactive among all artificial synthetic threads, and the tissue reaction is in the nature of a sluggish inflammation and lasts all the time that the thread is in the tissues. Initially, polyamide, or kapron, was produced twisted, then braided and monofilament threads appeared. According to the degree of tissue inflammatory response to these threads, they are arranged as follows: the least reaction to monofilament threads, more to braided threads, and even more to twisted threads. Of the polyamides used in surgical practice, monofilament threads are the most common; it should also be noted that the cost of these threads is the lowest. These threads are most often used for intradermal, removable, non-absorbable suture, for the suture of blood vessels, bronchi, tendons, aponeurosis, and is used in operative ophthalmology. The last polymer from the group of conditionally absorbable materials is polyurethane ester. Of all the monofilaments, it has the best handling properties. It is very plastic, has practically no thread memory, it is convenient to work with it in the wound. This is the only monofilament that can be knitted with three knots. Unlike polyamides, it does not support inflammation in the wound. When edema occurs in the wound, it does not allow it to cut through the inflamed tissue, and when the edema disappears, this thread acquires its original length, which does not allow the edges of the wound to disperse. It also happens with devices (beads) that allow you not to knit knots. This thread is used in general, plastic, vascular surgery, traumatology, gynecology.

• the third group is non-absorbable threads:
  • polyesters (polyesters or lavsan).
  • polypropylene (polyolefins)
  • group of fluoropolymer materials.

Polyester (polyester or lavsan) threads are more inert than polyamides, causing less tissue reaction. The threads are produced mainly braided and are distinguished by exceptional strength, at the same time, the use of these threads in surgery is increasingly limited, they are quietly disappearing from the arsenal of surgeons. This is due both to the appearance of synthetic absorbable threads, and to the fact that initially in all areas, except for strength, polyesters lose to polypropylenes. Currently, polyesters (polyesters) are used in 2 cases:

1. when it is necessary to sew tissues that are under tension for a long time after the operation and at the same time the most durable and reliable thread is needed;
2. in cases where a non-absorbable suture is needed in endosurgery.

These threads are used in cardiac surgery, traumatology, orthopedics, general surgery and in any other surgery where a strong non-absorbable thread is needed. The second group is polypropylenes (polyolefins). This material is produced only in the form of monofilaments from all of the above polymers, these threads are the most inert to human tissues, there is practically no reaction of tissues to polypropylenes, therefore they can be used in infected tissues or not removed if the wound has festered, in addition, they are used in cases where even a minimal inflammation reaction is undesirable, as well as in patients with a tendency to form a colloidal scar. The use of these threads never leads to the formation of ligature fistulas. The threads of this group have only two drawbacks: - they do not dissolve - they have worse handling properties than braided threads; they are knitted with a large number of knots. The scope of these threads is cardiovascular surgery, general surgery, thoracic surgery, oncology, traumatology and orthopedics, operative ophthalmology and any other surgery where a strong non-absorbable monofilament that does not cause an inflammatory reaction is needed. Fluoropolymers belong to the third group of non-absorbable threads. These are the latest scientific developments of all companies in the field of polymers from which surgical suture material is made. Scientists have noticed that if a fluorine-containing component is added to the polymer, the material acquires greater strength, becomes more flexible, plastic. These threads have the same properties and are used in the same operations as the threads of the polypropylene group. The only difference is that these threads are softer, more pliable, they can be knitted with fewer knots. The last material from the group of non-absorbable threads is STEEL and TITANIUM. Steel can be either in the form of monofilament or wicker. Steel monofilament is used in general surgery, traumatology and orthopedics, braided in cardiac surgery to make an electrode for temporary pacing. There are several ways to connect the thread to the needle. The most common is when a needle is drilled with a laser beam, a thread is inserted into the hole and crimped. This method is more reliable, since the strength of the needle and the strength of the “needle-thread” connection are maximally preserved. Some manufacturers continue to connect the thread with the needle in the old fashioned way: the needle is drilled in the base area, cut along, unfolded, the thread is inserted inside and around the thread it is twisted, while at the “needle-thread” junction, a weak spot is obtained in which the needle can bend, break, and also at the junction of the two edges of the needle, a burr is sometimes formed, which will injure the tissue when pierced with a needle. The strength of the “needle-thread” connection with this technology suffers. This causes the thread to come off the needle more often when pulled through the fabric. Currently, there are still reusable traumatic needles, where the thread is threaded into the eye of the needle. When such a thread passes through the tissue, a rough wound channel is created, which significantly exceeds the diameter of the thread. Much more blood bleeds from such a channel, tissue inflammation develops more often through it. These wounds take longer to heal. How important the atraumatic properties of the suture material are can be understood from the data of V. V. Yurlov, who, by switching from a non-traumatic needle and twisted nylon to an atraumatic monofilament suture material, reduced the incidence of anastomotic leaks from 16.6% to 1.1 %, and lethality from 26% to 3%.

Stapling needle classification

Needles according to piercing abilities are divided into:

• cylindrical (piercing);
• cylindrical with a cutting tip (taperkat);
• cylindrical with a blunt tip;
• triangular (cutting);
• triangular internal cutting (reverse cutting);
• triangular with a tip of extreme accuracy;

They are also classified according to the steepness of the bend: 1/2 encirclement, 5/8 encirclement, 3/8 encirclement, 1/4 encirclement.

Notes

Literature

• Petrov S.V. General Surgery: A Textbook for High Schools. - 2nd ed. - 2004. - 768 p. - ISBN 5-318-00564-0

see also

Wikimedia Foundation. 2010 .

• Hirt, Friedrich
• Hirhuf

See what "Surgical suture material" is in other dictionaries:

surgical instrument- Scalpels Surgical instrument specially made instrument for use during surgical interventions. Contents ... Wikipedia

surgical horse hair- (historical) suture material obtained by special processing of horsehair; used for cosmetic surgery... Big Medical Dictionary

surgical needle- in the needle holder Surgical needles ... Wikipedia

Catgut- (from the English catgut a string, a lace made from the intestines of animals, mainly sheep or cows) a self-absorbable surgical suture material, which is made from purified connective tissue obtained either from the serous layer ... ... Wikipedia

A thread- A thread is a flexible, thin and elongated object, whose length is several times greater than the thickness (cf. galactic or filament). The natural analogues of a thread are hair or cobwebs, which, however, can be used as a material for a thread ... ... Wikipedia

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In contrast to the very short-term impact on the edges of the wound with surgical needles, the suture material is in contact with the tissues for a long time.

Therefore, high demands are placed not only on the mechanical, but also on the biological properties of surgical threads.

Requirements for suture material

There is no universal suture material that fully meets all these requirements. Therefore, depending on the goals of the operation and the properties of the tissues that make up the edges of the wound, threads of different types are usually used sequentially.

Types of suture material

Polyglycolides (Vicryl, Dexon, Polysorb);
- polydioxanone (PDS, PDS II);
- polyurethane;
- polyamides (kapron);
- polyesters (lavsan, dacron, etibond);
- polyolefins (prolene, surgilen);
- fluoropolymers (gore-tex);
- polyvinylidene (coralene).

In some cases, metal wire is used to connect tissues.

According to the structure of the threads and their design features, suture materials are divided into the following types:

Monofilament threads;
- polyfilament threads;
- combined threads.

Depending on the rate of biodegradation, threads can be absorbable and non-absorbable. All suture materials vary in thickness. According to the European Pharmacopoeia (EP), the metric thread size corresponds to the minimum diameter value multiplied by 10.

In table. 1 also shows the conventional number in accordance with the American Pharmacopoeia (USP).

Table 1. Classification of suture material by thickness

Design features of the suture material

Monofilament threads (Prolene, Maxon, Ethylone, etc.) are based on a uniform fiber with a smooth surface.

Positive qualities of monofilament threads

Lack of "wick" and "sawing" properties;
pronounced elasticity and strength.

Disadvantages of monofilament threads

As a rule, these threads are unreliable in the knot due to the pronounced sliding of the surface.

To secure seams from monofilament threads, it is recommended to use multi-tier knots; polyfilament threads (dexon, vicryl, surgilon, etc.) consist of many fibers intertwined or twisted along the axis.

Positive properties of polyfilament threads

Good handling qualities; node reliability

Disadvantages of polyfilament threads

Their inherent "sawing" and "wick" properties, which can lead to the development of purulent complications in the wound; often occurring thread disintegration and ruptures of individual fibers.

One of the ways to improve these suture materials is to cover the multifilament base with an outer polymeric sheath. The threads obtained in this way belong to the category of combined ones (etibond, perma-hand, vicryl coated with polyglactin, etc.).

Positive properties of combined threads

Excellent handling qualities;
- minimal tissue damage;
- predicted with high accuracy the timing of resorption.

Disadvantages of combined threads

Relatively high cost;
- loss of positive properties during long-term storage;
- high probability of resorption of the outer shell with the loss of fastening properties.

Traditional sutures

The manipulation properties of silk have long been considered the "gold standard" in surgery. Silk thread is a complex of flexible, durable polyfilament fibers of various thicknesses. These threads are easily sterilized immediately before the operation and can be stored for a long time in 96% alcohol in ampoules or official packaging.

Silk is a non-absorbable suture material, since it remains in tissues for up to 6 months. Relative disadvantages include pronounced "wicking" and "sawing" properties, which limit the use of silk in modern surgery.

One of the directions for improving this material is the use of various coatings (for example, from wax, etc.), which make it possible to bring the properties of silk closer to the characteristics of a monofilament suture material.

The most famous and widespread absorbable natural suture material is catgut, a polyfilament thread from the submucosa of the intestine of mammals.

Positive properties of catgut

Good handling properties;
the ability to withstand a significant load;
formation of strong knots.

Disadvantages of catgut

Insufficient mechanical strength;
high reactogenicity and allergenicity;
pronounced absorption capacity;
- the timing of catgut resorption can vary widely (from 3 to 15 days), which may be either insufficient or excessive for scar formation.

Modern technologies allow you to adjust the period of resorption of catgut. In particular, chrome
catgut increases the resorption time and somewhat reduces the severity of the tissue reaction. In the same time
Etikon has developed a catgut with a reduced standard resorption time of up to 3 days.

Some properties of silk and catgut are given in Table. 2.

Table 2. Types of traditional suture materials

Modern non-absorbable suture materials and their applications

Their positive properties:

High strength, remaining in tissues for a long time;
- good handling properties;
- manufacturability;
- relative cheapness.

However, the constant presence of non-absorbable threads in the body can lead to the development of inflammatory reactions and subsequent scarring, which excludes their use for sutures on the bile ducts or urinary tract.

Polyamide suture materials (nurolon, standard, fluorolin, supramid) have high strength and flexibility, and are relatively quickly destroyed (up to 2 years). These threads cause the most pronounced local inflammatory changes, which limits their use for sutures on internal organs. The use of polyester threads (lavsan, terylene, dacron, mersilene, polyester, surjidak) leads to the development of a less pronounced tissue reaction.

To reduce "wicking" and "sawing" properties, they are used in the form of combined threads (etibond, ti-kron, m-dek, synthophil, fluorex). The most inert are polyolefin-based suture materials, which have strength, elasticity, reliability in the knot and versatility of properties. These include monofilament threads based on polypropylene (prolene, surgilen, surgipro).

Table 3. Types of non-absorbable sutures

Gore-tex (polytetrafluoroethylene), which is successfully used in vascular surgery and has high thromboresistance, can serve as an example.

Metal-based surgical threads (stainless steel, nichrome wire) are used to improve the reliability of sutures (connecting the edges of the sternum, suturing tendons, suturing the abdominal wall). They cause a minimal inflammatory response, but can provoke toxic or allergic complications.

The properties of some non-absorbable suture materials are given in table. 3.

Modern absorbable suture materials and their use

For a long time, sutures based on polyglycolic acid (dexon) and a copolymer of lactide and glycolide (vicryl) with resorption times of up to 90 days have been used in surgery. They are stronger than catgut, cause a slight inflammatory reaction.
However, Dexon and Vicryl are less elastic than non-absorbable materials. These sutures should not be used in cases where long-term suture strength is required (eg, after colorectal anastomoses).

To increase strength and reduce the "sawing" effect, combined filaments of vicryl with polyglactin 910 are produced. However, coating reduces the reliability of these filaments in the knot.

Monofilament materials such as polydioxanone (PDS, PDS II) and polytrimethylene carbonate (maxon) have a significant biodegradation period (up to 180-200 days) and high strength. They are characterized by minimal tissue reaction and significant elasticity. Maxon has better handling properties and greater knot strength than PDS. This contributes to its wide application.

Polysorb is one of the new generation suture materials. These are braided combined threads based on polyglycolic acid with a polymer coating.

Comparative evaluation of polysorb

1. According to its manipulation characteristics, polysorb is not inferior to silk.
2. Polysorb is easily pulled through tissues as a monofilament thread.
3. This suture is stronger than Vicryl.
4. Polysorb is characterized by increased reliability of the assembly.

However, long-term clinical trials are needed for a final conclusion about the properties of Polysorb.

Table 4. Absorbable suture materials used in modern surgery

High strength, atraumaticity and long resorption time are possessed by the bioxin monofilament thread based on glycolide, dioxanone and trimethylene carbonate. Such threads are successfully used for intradermal continuous suture.

Monofilament suture materials with long resorption periods (90-120 days) also include monocryl, a copolymer of glycolide and epsilon-caprolactone.

Thus, modern absorbable suture materials can be used in all areas of surgery, especially for the suture of muscles, aponeuroses, walls of hollow organs, bile ducts, and urinary tract.

Comparative characteristics of some of the most commonly used absorbable suture materials are presented in Table. four.

G.M. Semenov, V.L. Petrishin, M.V. Kovshova