Considerations When Using Non-Absorbable Sutures
Considerations when using non-absorbable sutures can differ on your body type, your wound or the material the doctors using. Suture is not a complicated process, but that doesnt mean it has to be done perfectly. In this article, we are trying to explain what is suture and what is non-absorbable suture.
Main Components of the Suture
Two main words when talking about the suture in and out of surgery: Needles and threads. The features expected from an ideal needle are that it is hard enough to sew without bending, it creates minimal trauma, high sharpness, resistance to corrosion and rusting, resistant to peeling and sterile. They are made of stainless steel. All real stainless steel needles contain at least about 12 percent chromium, which provides a thin, electrically protective layer of chromium oxide on the surface.
The places of use are determined according to the properties of the suture materials. It is necessary to know some definitions and considerations when using non-absorbable sutures in order to determine the usage areas.
The Meaning of Tensile Strenght
The tensile strength defines the ‘breaking force’, the force required for the seam to break with a complete cross-section at both ends, without disturbing its structure. Tensile strength loss and absorption rate reduction are not the same concepts. The more tension the tissues are under, the higher the tension strength of the suture used should be. Thin threads with low tensile strength should not be used in high tensile tissues and wounds. These facts can change the considerations when using non-absorbable sutures.
The terms melt rate, tensile strength and loss rate are not interchangeable. Although the rate of dissolution is important for the suture complications that occur in the late stage. The rate of loss of tensile strength is of greater importance for surgeons when the primary task of the suture is considered. Its ability to keep the tissues close to each other during the healing period is very important. This begs the quesiton what are 3 types of sutures?
When assessing the in-vivo tensile strength of a fusible seam, specific measurements of the manufacturer’s holding capacity should be given, rather than the percentage of original tensile strength preservation.
Tensile strength standards for synthetic fusible non absorbable sutures types have been established by the USP. If manufacturers use these standards to describe tensile strength, surgeons may have a valid clinical perspective for evaluating suture performance.
How Do You Choose the Type of Suture
The use of USP standards is especially important when there are significant differences in the initial tensile strength of synthetic seams.
Plasticity (shapeability) is the property of keeping the new shape and length after stretching or pulling the suture.
Pliability is the ability of the suture to be bent, twisted and folded.
The friction coefficient is a measure of the resistance between the fabric and the yarn itself, it indicates the slipperiness. These are the considerations when using non-absorbable sutures.
Currently, two main standards are used in the absorbable and nonabsorbable suture material. They are standardized by USP (United States Pharmacopoeia) and EP (European Pharmacopoeia). USP is more widely used.
- 7/0 and finer: Ophthalmology, microsurgery
- 6/0 : Facial, vascular surgery
- 5/0 : Face, neck, vascular surgery
- 4/0 : Mucosa, neck, hand, extremity, tendon, vein
- 3/0 : It is used in extremity, trunk, bowel, vascular surgery.
Monofilament and Multifilament Sutures
Monofilament (single bundle-fiber) sutures are resistant to infection. Their memories are very strong. They create less reaction, they are slippery, they are easy to pass through the tissue. They are the most suitable sutures in contaminated traumatic wounds. However, their knot security is weak. Main considerations when using non-absorbable sutures are their difficulty in usage. They lose 50% of their tensile strength when held with a tool.
Multifilament (multi-bundle-fiber) nonabsorbable sutures are soft and easy to use. They are wear resistant. They have high tensile strength, flexibility, elasticity and knot security. However, due to their high capillarity, they absorb liquid. They create an environment for infection. They pass through the tissue and cause high tissue damage. They cause a reaction.
Capillarity is the transport of fluid and bacteria along the suture line between sutures in multifilament sutures. Capillarity is present in all multifilament sutures. These can be reduced by coating, but not completely destroyed. There is no capillarity in non absorbable monofilament sutures.
Natural Fiber Sutures
Natural nonabsorbable suture types have many disadvantages. First of all, these natural fibrous fusible stitches have a tendency to wear out when knotting. Secondly, there is much variation in the maintenance of tensile strengths compared to synthetic fusible stitches.
Absorbable sutures are used in rapidly healing tissues (stomach, colon, bladder). In wounds where cosmetic results are important, monofilament (nylon, polypropylene) subcuticular sutures should be used as small as possible. Absorbable sutures in the biliary and urinary system, which provide a suitable environment for stone formation, should be used.
The reaction of the material used in the tissue is also in the considerations when using non-absorbable sutures. While stainless steel has the least reaction, chromium catgut has the most reaction. The order from low to high in reaction formation is as follows: polypropylene, polydiaxanone, polyglactin, polyglactin 910, polybutylate, polyester, polyamide, silk, plain catgut.