Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
Sutura Quimica
Suture materials are usually an afterthought to most of us and commonly taken for granted. Yet, without an understanding of suture materials, their advantages, and disadvantages, a surgeon may unnecessarily be risking the success of surgery. The following is a review of some of the most commonly used sutures in veterinary medicine, as well as some newer materials that are becoming increasingly available. Suture can classically be divided into one of several categories such as absorbable, non-absorbable, monofilament, multifilament, etc. Non-absorbable is usually used in situations where you intend to remove the suture (skin sutures) or the suture is meant to provide strength for a significant period of time (ligament repair). The ideal absorbable suture will be pliable, sterile, have a uniform tensile strength, non-inflammatory, degrade at just the right time, be strong enough to support the repair, and be inexpensive. Below are some of the key aspects to be familiar with when using suture.
Key properties and characteristics of suture
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Property
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Definition
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Breaking strength
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Stress value on the stress-strain curve at which suture acutely fails
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Capillarity
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Degree to which absorbed fluid is transferred along suture
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Creep
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Tendency of suture to slowly and permanently deform under constant stress
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Elasticity
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Degree which a suture will deform under stress or load and return to its original form when the load is removed
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Knot pull-out strength
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The load required to break a suture deformed by a knot
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Knot strength
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Force necessary to cause a knot to slip
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Memory
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Tendency for a suture to return to its original shape after deformation
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Plasticity
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Degree to which suture will deform without breaking and will maintain its shape after removal of the deforming force
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Pliablity
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Ease of handling and ability to change the shape of suture
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Stress relaxation
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Ability of suture to reduce stress under constant strain
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Tensile strength
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Ability to resist deformation and breakage and the stress at which deformation (yield strength) or rupture (breaking or ultimate strength) occurs
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Basic differences of suture
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Monofilament
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Multifilament
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Single stranded
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Braided or twisted
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More susceptible to crush or nicking
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Less susceptible to crush or nicking
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Lower tissue drag
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Higher tissue drag
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Less pliable
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More pliable
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Less capillarity
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Greater capillarity
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Less bacterial colonization
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More bacterial colonization
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Common absorbable sutures
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Name
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Trade name
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Facts/advantages/disadvantages
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Poliglecaprone 25
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Monocryl
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Completely absorbed in 90–120 days
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Glycomer 631
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Biosyn
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50% strength at 2–3 weeks
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Polydioxanone
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PDS II
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50% strength at 5–6 weeks, 180 day absorption
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Polyglyconate
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Maxon
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50% strength in 4–5 days, 180 day absorption
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Polyglycolic acid
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Dexon
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50% strength at 2–3 weeks
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Polyglactin 910
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Vicryl
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Absorbed in 56–70 days
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Lactomer 9-1
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Polysorb
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Do not use for cardiovascular or neurologic surgery
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Polyglytone 6211
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Caprosyn
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No measurable strength after 6 weeks
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Common non-absorbable sutures
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Name
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Trade name(s)
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Facts/advantages/disadvantages
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Polyblends
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Fiberwire, Orthofiber
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Polyester composites that have improved breaking strength and fray resistance
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Polyester fiber
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Mersilene, Ethibond, Ticron,
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Available in monofilament or multifilament, used to make thrombogenic coils
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Nylon
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Ethilon, Monosof, Nurolon, Dermalon, Surgilon, Bralon
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Actually is susceptible to degradation via hydrolysis
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Polymerized caprolactam
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Supramid, Vetafil
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Only recommended on skin
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Polypropylene
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Prolene, Surgipro, Surgilene
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Higher energy break point than silk, nylon, polyester, and polyglycolic acid
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Barbed suture is relatively new to the veterinary field, but it is interesting to note it was first developed in 1964. There are many studies in the human literature, which suggest an increase in speed of closure since no knots are needed. However, a clear advantage beyond that is not always there. These types of sutures are not surprisingly expensive, yet they are clearly attractive for application in minimally invasive surgery.
Barbed sutures
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Quill self-retaining system
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Bi-directional barbed suture
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V-loc absorbable wound closure device
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Unidirectional barbed suture with one needle and a loop at the end
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Stratfix knotless tissue control device
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Spiral distribution of barbs
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