Synthetic absorbable sutures
Absorbable sutures is the only variant for temporal holding the edges of a wound till its healing. The period of time needed for healing the wound is the time while the suture shouldn’t lose its strength.
Though the time of healing of the wound is only the second criterion at choosing the suture. The first criterion remains to be its influence on surrounding tissues and the way of destruction. For example the absorbable sutures of natural origin ( catgut, silk) destroy under the influence of ferments. The synthetic sutures undergo hydrolysis – the inner disintegration with water. Hydrolysis causes less reaction of tissues unlike ferment disintegration, so synthetic absorbable sutures are more preferable for the ligation of temporal stitches.
All synthetic absorbable sutures fall into two groups:
1.Polyfilament sutures ( made of several fibers). These are such sutures as PGA, Polysorb, Dyxon, Vicryl, Darvin. The common features of this group are high durability ( in comparison to natural sutures), almost ideal time of losing the durability and absorbation. For example Vicryl, Dixon and Darvin lose their durability in two weeks Polysorb – for three weeks. After the operation the polyfilament sutures resolve entirely during 2-3 months.
However Vicryl has stronger sawing effect in comparison to other polyfilament sutures, more inflexibility, less elasticity. In order to reduce the sewing effect of Vicryl and other threads of this group the special covering is used, though it requires more knots for knot and stitch durability. Among all the polyfilament sutures α-PGA with covering has the best characteristics.
These sutures are recommended to apply in tissues where the tension is high ( different hernias). These sutures should be carefully used at anastomosis of gullet and large intestine, while operating on the patients at the later stage of cancer, and patients after chemotherapy or radiotherapy – in all those cases when the regeneration of tissues is reduced slow down.
The usage of the synthetic polyfilaments is preferable during the operations where the reaction of tissues should be avoided ( suturing of pancreas, some definite plastic operations etc.)
2.Monofilament sutures ( made of one fiber). These are Maxon and polydioxanone ( PDO). Both of the material have minimum sewing effect, keep high durability in tissues, more flexible and less reactionary than polyfilaments.
However monofilament synthetic sutures have some definite disadvantages:
In general synthetic absorbable sutures are more popular among the surgeons thanks to their main distinctive feature – the full absorption after performing their function. That’s why it is not surprising that 80% of all manufactured absorbable sutures are synthetic.
However every operation requires maximum taking into account all the peculiarities of the organism, the exact forecasting of course of the healing of the wound. Only in such case the right choice of the suture material can be done.