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Surgical sutures and ligatures are threads or strings specially prepared and sterilized
for use in surgery. The former one is used for sewing tissues etc. together and the
later one for tying blood vessels and other tissues.
Different type of materials are in use for these purposes. They are intestinal tissues
and tendons of a large assortment of animals and birds, various kind of thread spun
from vegetable fibers, human hair, horse and camel hair, synthetic threads and
metallic wire.
In the former type are found those materials that are absorbed or digested in the
tissues in the body after their suturing or ligaturing function has been performed
and, provided the material is non irritant and sterile, may be left in the body with
confidence.
Catgut, the classic absorbable suture derived from collagen rich animal tissue
(usually using selective layers of sheep intestine) , is proteinacious in nature and it
appears that certain proteolytic enzymes in tissues are responsible for the digestion
of catgut and its disappearances from the wound area.
The later type since insoluble/not digested or not absorbed in the body, their use
will depend among other things, non irritant properties. They may disintegrate after
a long period but commonly become encysted without causing any problem.
Surface stitches using non absorbing materials bind the edges of a wound and are
removed after healing has taken place.
• Their strengths must be adequate for the purpose for which they are used.
• Sutures that undergo rapid degradation in tissues losing their tensile strength within
60 days are considered absorbable sutures.
• Those that retain their tensile strength for longer than 60 days are non absorbable
sutures/ligatures.
Non absorbable sutures are, in like manner, sutures that are not dissolved or
decomposed by the body’s natural action. Such sutures are generally not naturally
occurring materials (with the exception of silk). Some (silk and nylon) while being
classified as non absorbable actually dissolve after a prolong period of time
compared to that of absosrbable materials.
A further subdivision of suture materials is Monofilament and Multifilament.
Sutures are manufactured with a wide variety of parameters. They can be mono
filament or multi filaments twisted together, spun together or braided. They can also
be dyed, un dyed, coated, not coated.
With the goal of understanding the effects of so many variations of suture type, the
properties and material of which they are composed are and have been studied in
depth. The use of sutures is one of the most common practices in the medical field
and thus has direct effect on a majority of the world’s population.
As there are several different suture materials and needles that provide an accurate
and secure approximation of the wound edges, ideally, the choice of the suture
material should be based on the biological interaction of the materials employed,
tissue configuration, and the biochemical properties of the wound. The tissue should
be held in apposition until the tensile strength of the suture is sufficient to withstand
stress.
According to the Medical Device Amendments Act of Federal Food, Drug and
Cosmetic Act, 1976 several sutures used in practice have been reclassified from class
III to class II.
According to U.S.P. (27th Edn.) non absorbable suture is classified and typed as
follows:
• The sizes and tensile strengths for all sutures are standardized by U.S.P. regulations.
Size denotes the diameter of the material (mm) and the tensile strength in Newton.
• Stated numerically, the more zeroes in the number, the smaller the size of the
strand. 00000 is referred to as 5-0, for example which is smaller than a size 4-0. The
smaller the diameter, the less is tensile strength. Tensile strength of the suture is the
tension that the strand will withstand before it breaks when knotted.
• The use of various dimension of the sutures is very much dependent on the location,
of the injury, type of protection needed etc. etc.
• When the tubing fluid contains any water the tubes of the catgut are labeled “Non-
boilable”.
• If the tubing fluid is anhydrous, the tubes may be boiled before opening for its use in
reality.
• Non boilable tubes are filled with alcohol containing small quantity of water.
• Among the widely accepted methods for the sterilization of sutures, autoclave
sterilization with free access of water vapor, applicable only for those sutures that
are not harmed by this process. Dry heat at 310º F ; ethylene oxide ; and irradiation
sterilization using either β or γ rays.
• The sutures are sterilized in their final sealed packages, eliminating any danger of
recontamination.
• The radiation dose is considered to be 40% greater than necessary to kill even the
most resistant spore forming organisms, each suture receiving a minimum dose of
2.5 mega rads.
• Irradiation sterilized surgical gut is stronger, more pliable and easier to handle than
dry heat sterilized surgical gut sutures.
• In the irradiation process the prepared gut is packed in aluminum foil envelopes
containing 90% isopropyl alcohol as preservative. The envelopes are then passed
through an irradiation area on a conveyer system. Thus the catgut is sterilized when
sealed in its final container and since the process is rapid, there is no lengthy hold up
of material as in other processes. The exterior of the packet is sterilized before
opening by immersion in a solution of 1% formaldehyde in 90% isopropyl alcohol.