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Absorbable Sutures

Chapter 4: Table of Contents

Absorbable Sutures

Absorbable sutures are generally chosen to appose and ligate tissue that will be inaccessible after implantation. Absorbable suture materials are often chosen because they degrade overtime and do not require removal after healing has occurred. Theoretically, absorbable materials lose their initial tensile strength within 60 days. However, some materials will still take several months to disappear completely. Absorbable suture materials are either natural or synthetic. Chromic catgut is a natural absorbable suture material. Chromic catgut has weak tensile strength and creates a marked inflammatory tissue reaction. It is absorbed by phagocytosis and tends to be absorbed more rapidly in tissues with high vascularity, increased digestive enzymes (e.g. stomach or urinary bladder), infected tissues, or in hypoproteinemic patients. Synthetic suture materials include polyglactin 910, glycomer-631, polydioxanone, poliglecaprone-25, etc. These materials are often selected since they have greater tensile strength, reduced tissue reactivity, and perform better in infected tissues. Degradation of these synthetic materials occurs by hydroxylation of chemical bonds resulting in a more predictable loss of tensile strength.

Absorbable Suture Material

Polydioxanone (PDS®):

Polydioxanone is a synthetic, absorbable monofilament suture material available in various sizes (2 to 9-0).  It has good knot security and causes minimal tissue reaction.  The tensile strength of this synthetic material is retained longer than the other absorbable synthetic materials.  Monofilament suture materials tend to be more difficult to handle than multifilaments due the materials’ stiffness and memory.  The handling characteristics of this material are typical for a monofilament suture.  PDS is degraded by hydrolysis of the polymer’s chemical bonds, and is completely absorbed after approximately 180 days.

Polyglecaprone 25 (monocryl®):

Polyglecaprone 25 is a synthetic, absorbable monofilament suture material available in various sizes (2 to 6-0).  It has excellent knot security and causes minimal tissue reaction.  The tensile strength of this synthetic material is lost rapidly compared to other absorbable synthetic material, but its initial tensile strength is high.  This material has exceptional handling characteristics for a monofilament suture, due to a lack of stiffness and memory.  Polyglecaprone 25 is degraded by hydrolysis of the polymer’s chemical bonds, and is completely absorbed after approximately 120 days.

Polyglactin 910 (Vicryl®):

Polyglactin 910 is a synthetic, absorbable multifilament (braided) suture material available in various sizes (3 to 8-0).  It has moderate relative knot security and minimal tissue reaction.  The loss of tensile strength of this synthetic material is moderate to rapid compared to other absorbable synthetic materials (tensile strength is lost faster than polydioxanone and polyglyconate, slower than polyglecaprone 25 and at a similar rate compared to polyglycolic acid.  Polyglactin 910 is also available in a coated format; it is coated with calcium stearate and a layer of a glycolide and lactide copolymer to reduce tissue drag.  Vicryl Rapide® is absorbed more rapidly than Vicryl® and is designed for fast healing tissues (tensile strength is completely lost at 10-14 days).  Polyglactin 910 is degraded by hydrolysis of the polymer’s chemical bonds, and is completely absorbed after approximately 60 days.

Glycomer 631 (Biosyn®):

Glycomer 631 is a synthetic absorbable monofilament suture material available in various sizes (1 to 6-0).  It is composed of glycolide, dioxanone and trimethylene carbonate and possesses excellent knot security and causes minimal tissue reaction.  Glycomer 631 has excellent initial tensile strength, and the loss of the tensile strength is moderate compared to other absorbable sutures; It looses tensile strength faster than PDS but slower than plyglycolic acid, plyglecaprone 25 and polyglactin 910.  Glycomer 631 suture is degraded by the hydrolysis of the polymer’s chemical bonds, and is completely absorbed after approximately 110 days.

Catgut:

Catgut or surgical gut is a natural absorbable multifilament suture material available in various sizes (3 to 7-0).  Despite its name, catgut is composed from either sheep intestinal submucosa or bovine intestinal serosa.  Exposure of this material to chromic salts will cause cross-linking of the collagen fibers and slow the absorption rate according to its exposure time.  The cross-linking of the collagen fibers will improve the tensile strength compared to the plain catgut, but chromic catgut is still characterized with a weak initial tensile strength.  Plain and chromic catgut cause a marked inflammatory reaction compared to synthetic materials.  Infection and release of proteolytic enzymes can lead to variability in the absorption rate, resulting in the early loss of tensile strength.  Unlike synthetic absorbable suture materials, catgut suture is absorbed by phagocytosis and this is slowed by the chromic salt treatment.

Polyglycolic Acid (Dexon®):

Polyglycolic acid is a synthetic, absorbable multifilament (braided) suture material available in various sizes (2 to 6-0).  It has moderate relative knot security and causes minimal tissue reaction.  The loss of tensile strength of this synthetic material is moderate to rapid compared to other absorbable synthetic material (tensile strength is lost faster than polydioxanone and polyglyconate, slower than polyglecaprone 25 and similarly to polyglactin 910).  Polyglycolic acid is available as coated (Dexon II) and uncoated (Dexon S) materials.  Polyglycolic acid suture is degraded by hydrolysis of the polymer’s chemical bonds, and is completely absorbed after approximately 90 days.

Polyglyconate (Maxon®):

Polyglyconate is a synthetic, absorbable monofilament suture material available in various sizes (2 to 7-0).  It has good relative knot security and causes minimal tissue reaction.  This material maintains its tensile strength for a relatively long time; it is comparable to PDS and considerably longer than polyglycolic acid and polyglactin 910.   It is easier to handle than many other synthetic materials despite its monofilament composition.  Polyglyconate suture is degraded by hydrolysis of the polymer’s chemical bonds, and is completely absorbed after approximately 180 days.

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