Many Kinds Of Sutures Biology Essay

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A surgical suture is used to close the edges of a wound or incision and to repair damaged tissue. There are many kinds of sutures, with different properties suitable for various uses. Sutures can be divided into two main groups: absorbable and non-absorbable. An absorbable suture decomposes in the body. It degrades as a wound or incision heals. A non-absorbable suture resists the body's attempt to dissolve it. Non-absorbable sutures may be removed by a surgeon after a surface incision has healed.

Sutures are made from both man-made and natural materials. Natural suture materials include silk, linen, and catgut, which is actually the dried and treated intestine of a cow or sheep. Synthetic sutures are made from a variety of textiles such as nylon or polyester, formulated specifically for surgical use. Absorbable synthetic sutures are made from polyglycolic acid or other glycolide polymers. Most of the synthetic suture materials have proprietary names, such as Dexon and Vicryl. The water-resistant material Goretex has been used for surgical sutures, and other sutures are made from thin metal wire.

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Sutures are also classified according to their form. Some are monofilaments, that is, consisting of only one thread-like structure. Others consist of several filaments braided or twisted together. Surgeons choose which type of suture to use depending on the operation. A monofilament has what is called low tissue drag, meaning it passes smoothly through tissue. Braided or twisted sutures may have higher tissue drag, but are easier to knot and have greater knot strength. Braided sutures are usually coated to improve tissue drag. Other sutures may have a braided or twisted core within a smooth sleeve of extruded material. These are known as pseudo-monofilaments. A suture can also be classified according to its diameter. In the United States, suture diameter is represented on a scale descending from 10 to 1, and then descending again from 1-0 to 12-0. A number 9 suture is 0.0012 in (0.03 mm) in diameter, while the smallest, number 12-0, is smaller in diameter than a human hair.

Suture manufacturing comes under the regulatory control of the Food and Drug Administration (FDA) because sutures are classified as medical devices. Manufacturing guidelines and testing for the industry is provided by a non-profit, non-governmental agency called United States Pharmacopeia, located in Rockville, Maryland.

Why We Choose Surgical Suture?

We choose surgical suture because it is an interesting material. After we knew about surgical suture, we become more curious about it. So, we really want to know more about it. The more we read about it, the more interesting it become. Moreover, surgical suture is very important in our life. It help us if we injured. For a conclusion, this is a valueable knowledge that is very useful for our future.

What Is Surgical Suture?

Surgical suture is a medical device used to hold body tissues together after an injury or surgery. They generally consist of a needle with an attached length of thread. It is a process of joining two surfaces or edges together along a line by or as if by sewing. Materials that are needed for this procedure are thread, gut or wire. It is also a stitch or series of stitches made to secure apposition of the edges of a surgical or traumatic wound.

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Application

Surgical suture application in medicine are:

The fine thread or other material used surgically to close a wound or join tissues.

catgut, silk thread, or wire used to stitch together two bodily surfaces.

Property Of Surgical Suture

Ideal suture property

The ideal suture has the following properties:

Sterile

All-purpose (composed of material that can be used in any surgical procedure)

Causes minimal tissue injury or tissue reaction (ie, nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic)

Easy to handle

Holds securely when knotted (ie, no fraying or cutting)

High tensile strength

Favourable absorption profile

Resistant to infection

Unfortunately, at present, no single material can provide all of these properties. In different situations and with differences in tissue composition throughout the body, the requirements for adequate wound closure require different suture properties.

Essential suture property

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All sutures should be manufactured to assure several fundamental properties, as follows:

Sterility

Uniform diameter and size

Pliability for ease of handling and knot security

Uniform tensile strength by suture type and size

Freedom from irritants or impurities that would elicit tissue reaction

Other suture properties

The following terms describe various properties related to suture material:

Absorbable - Progressive loss of mass and/or volume of suture material; does not correlate with initial tensile strength

Breaking strength - Limit of tensile strength at which suture failure occurs

Capillarity - Extent to which absorbed fluid is transferred along the suture

Elasticity - Measure of the ability of the material to regain its original form and length after deformation

Fluid absorption - Ability to take up fluid after immersion

Knot-pull tensile strength - Breaking strength of knotted suture material (10-40% weaker after deformation by knot placement)

Knot strength - Amount of force necessary to cause a knot to slip (related to the coefficient of static friction and plasticity of a given material)

Memory - Inherent capability of suture to return to or maintain its original gross shape (related to elasticity, plasticity, and diameter)

Nonabsorbable - Surgical suture material that is relatively unaffected by the biological activities of the body tissues and is therefore permanent unless removed

Plasticity - Measure of the ability to deform without breaking and to maintain a new form after relief of the deforming force

Pliability - Ease of handling of suture material; ability to adjust knot tension and to secure knots (related to suture material, filament type, and diameter)

Straight-pull tensile strength - Linear breaking strength of suture material

Suture pullout value - The application of force to a loop of suture located where tissue failure occurs, which measures the strength of a particular tissue; variable depending on anatomic site and histological composition (fat, 0.2 kg; muscle, 1.27 kg; skin, 1.82 kg; fascia, 3.77 kg)

Tensile strength - Measure of a material or tissue's ability to resist deformation and breakage

Wound breaking strength - Limit of tensile strength of a healing wound at which separation of the wound edges occurs

Suture size

The 3 classes of sutures are collagen, synthetic absorbable, and nonabsorbable. Size refers to the diameter of the suture strand and is denoted as zeroes. The more zeroes characterizing a suture size, the smaller the resultant strand diameter (eg, 4-0 or 0000 is larger than 5-0 or 00000). The smaller the suture, the less tensile strength of the strand

Raw Material

Thread

Suture thread is made from numerous materials. The original sutures were made from biological materials, such as catgut suture and silk. Most modern sutures are synthetic, including the absorbables polyglycolic acid, polylactic acid, and polydioxanone as well as the non-absorbables nylon and polypropylene. Newer still is the idea of coating sutures with antimicrobial substances to reduce the chances of wound infection.Sutures come in very specific sizes and may be either absorbable (naturally biodegradable in the body) or non-absorbable. Sutures must be strong enough to hold tissue securely but flexible enough to be knotted. They must be hypoallergenic and avoid the "wick effect" that would allow fluids and thus infection to penetrate the body along the suture tract.

Absorbability

All sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time. Absorbable suture materials include the original catgut as well as the newer synthetics polyglycolic acid (Biovek), polylactic acid, polydioxanone, and caprolactone. They are broken down by various processes including hydrolysis (polyglycolic acid) and proteolytic enzymatic degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues. In both cases, they will hold the body tissues together long enough to allow healing, but will disintegrate so that they do not leave foreign material or require further procedures. Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.

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Non-absorbable sutures are made of special silk or the synthetics polypropylene, polyester or nylon. Stainless steel wires are commonly used in orthopedic surgery and for sternal closure in cardiac surgery. These may or may not have coatings to enhance their performance characteristics. Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice. Examples include the heart ( with its constant pressure and movement) or the bladder (with adverse chemical conditions). Non-absorbable sutures often cause less scarring because they provoke less immune response, and thus are used where cosmetic outcome is important. They must be removed after a certain time, or left permanently.

http://upload.wikimedia.org/wikipedia/commons/thumb/1/12/Sutures.jpg/275px-Sutures.jpg nonabsorbable sutures in a person's left thumb.

Sizes

Suture sizes are defined by the United States Pharmacopeia (U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2/0) to #000000 (#6-0 or #6/0).

Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.

U.S.P.

Designation

Collagen

metric diameter

(mm)

Synthetic absorbable

metric diameter

(mm)

Non-absorbable

metric diameter

(mm)

American wire gauge

11-0

0.01

10-0

0.02

0.02

0.02

9-0

0.03

0.03

0.03

8-0

0.05

0.04

0.04

7-0

0.07

0.05

0.05

6-0

0.1

0.07

0.07

38-40

5-0

0.15

0.1

0.1

35-38

4-0

0.2

0.15

0.15

32-34

3-0

0.3

0.2

0.2

29-32

2-0

0.35

0.3

0.3

28

0

0.4

0.35

0.35

26-27

1

0.5

0.4

0.4

25-26

2

0.6

0.5

0.5

23-24

3

0.7

0.6

0.6

22

4

0.8

0.6

0.6

21-22

5

0.7

0.7

20-21

6

0.8

19-20

7

18

Needles

Traumatic needles are needles with holes or eyes which are supplied to the hospital separate from their suture thread. The suture must be threaded on site, as is done when sewing at home.

Atraumatic needles with sutures comprise an eyeless needle attached to a specific length of suture thread. The suture manufacturer swages the suture thread to the eyeless atraumatic needle at the factory. There are several advantages to having the needle pre-mounted on the suture. The doctor or the nurse or odp does not have to spend time threading the suture on the needle. More importantly, the suture end of a swaged needle is smaller than the needle body. In traumatic needles with eyes, the thread comes out of the needle's hole on both sides. When passing through the tissues, this type of suture rips the tissue to a certain extent, thus the name traumatic. Nearly all modern sutures feature swaged atraumatic needles.

There are several shapes of surgical needles, including:

straight

half curved or ski

half curved at both ends of a straight segment or canoe

1/4 circle

3/8 circle

1/2 circle

5/8 circle

compound curve

The ski and canoe needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.

Needles may also be classified by their point geometry; examples include:

taper (needle body is round and tapers smoothly to a point)

cutting (needle body is triangular and has a sharpened cutting edge on the inside)

reverse cutting (cutting edge on the outside)

trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)

blunt points for sewing friable tissues

side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery

Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These "pop-offs" are commonly used for interrupted sutures, where each suture is only passed once and then tied.

http://upload.wikimedia.org/wikipedia/commons/thumb/3/3a/HechtnaaldenB.jpg/120px-HechtnaaldenB.jpg

Surgical needles which form 3/8th of a circle, in different sizes.

http://upload.wikimedia.org/wikipedia/commons/thumb/2/28/HechtnaaldenG.jpg/120px-HechtnaaldenG.jpg

Surgical needles which are semicircular, in different sizes.

U.S.P. Needle Pull Specifications

U.S.P.

Suture Size

Average Minimum

(kgf)

Individual Minimum

(kgf)

11-0

0.007

0.005

10-0

0.014

0.010

9-0

0.021

0.015

8-0

0.050

0.025

7-0

0.080

0.040

6-0

0.170

0.080

5-0

0.230

0.110

4-0

0.450

0.230

3-0

0.680

0.340

2-0

1.100

0.450

0

1.500

0.450

1

1.800

0.600

2+

1.800

0.700

The Manufacturing Process

The manufacturing of sutures for surgical use is not very different from the production of other synthetic textiles. The raw material is polymerized, and the polymer extruded into fiber. The fiber is stretched and braided on machines similar to ones that might be found in a factory producing polyester thread for the garment industry. The manufacturing process typically occurs at three sites: one plant produces the suture textile, another produces the needles, and a third plant called the finishing plant attaches needles to the sutures, packages, and sterilizes.

The first step in suture manufacturing is to produce the raw polymer. Workers measure the chemicals making up the polymer into a chemical reactor. In the reactor, the chemicals are combined (polymerized), forced through a die, and discharged as tiny pellets.

Next, workers empty the pellets into an extrusion machine. The extruder has a nozzle, looking something like a shower head, pierced with many tiny holes. The machine melts the polymer, and the liquid flows through the tiny holes, forming many individual filaments.

After extrusion, the filaments are stretched between two rollers. The filaments stretch to as much as five times their original length.

Some sutures are produced as monofilaments. Others are braided or twisted. To braid the suture, the extruded monofilament is wound onto bobbins, and the bobbins are loaded onto an automatic braiding machine. Such a machine is typically of an old design that might also be used in the manufacture of textiles for fabric. The number of filaments braided together depends on the width of the suture made for the particular batch. A very fine suture might braid 20 filaments, a medium width hundreds, and a very thick suture might braid thousands of filaments. The braiding machine produces one continuous strand of braided material. It works very slowly, and typically the machine is set to run for as long as four weeks at a time. The process is almost entirely automatic. Workers in the plant inspect the equipment for break-downs and reload empty bobbins, but generally the process requires little man-power.

After braiding, the suture undergoes several stages of secondary processing. Non-braided sutures will also go through these steps after extrusion and initial stretching. Workers load the material onto another machine that performs another stretching and pressing operation. Unlike the first stretching, this step might take only a few minutes, and adds to the length of the material by only about 20%. The suture passes over a hot plate, and any lumps, snags, or imperfections are ironed out.

Next, workers pass the suture through an annealing oven. The annealing oven subjects the suture to high heat and tension, which actually orders the crystalline structure of the polymer fiber into a long chain. This step may take several minutes or several hours, depending on the type of suture being made.

After annealing, the suture may be coated. The coating material varies depending on what the suture is made of. The suture passes through a bath of coating material, which may be in solution or may be in a thick, paste-like state called a slurry.

All the major manufacturing steps at the processing plant are complete at this point. Now the quality assurance workers test the batch of suture for various qualities. These workers make sure the suture conforms to the proper diameter, length, and strength, look for physical defects, and check the dissolvability of an absorbable suture in animal and test-tube tests. If the batch passes all the tests, it is shipped to a finishing plant.

The surgical needles are made at another plant, and also shipped to the finishing plant. The needles are made of fine steel wire, and drilled lengthwise. Workers at the finishing plant cut the suture into standard lengths. The length of suture is mechanically inserted into the hollow in the needle, and the needle is crimped onto the fiber. This process is called swaging.

Next, the suture and attached needle are inserted into a foil packet and sterilized. Sterilization differs according to the suture material. Some sutures are sterilized with gamma radiation. In this case, the sutures are packaged completely. The whole package, typically a sealed foil pack inside a cardboard box, is set on a conveyor belt. The sealed package passes under pencil-shaped lenses emitting gamma radiation. This kills all microbes. The suture is now ready for shipment. Some suture material cannot withstand gamma radiation, and it is sterilized in a different process. The suture and needles are packaged in a foil pack, but the pack is left open. The packages move into a gas chamber, which is then filled with ethylene oxide gas. Then the foil packs are sealed, inserted into boxes or other packaging, and readied for shipment.

The Products

Product

Material

Effective Wound Support

Absorption Time (Days)

CAPROSYNâ„¢

Monofilament

10 Days

< 56

POLYSORBâ„¢

Coated & Braided

3 Weeks

56 - 70

DEXONâ„¢ II

Coated , Braided

3 Weeks

60 - 90

DEXONâ„¢ S

Uncoated , Braided

3 Weeks

60 - 90

BIOSYNâ„¢

Monofilament

3 Weeks

90 - 110

MAXONâ„¢

Monofilament

6 Weeks

180

MAXONâ„¢ CV

Monofilament

6 Weeks

180

Chromic Gut

Gut Fibre with Chromium Salt

Variable* - Refer to package insert.

Variable* - Refer to package insert.

Mild Chromic Gut

Gut Fibre with Chromium Salt

Variable* - Refer to package insert.

Variable* - Refer to package insert.

Plain Gut

Gut Fibre

Variable* - Refer to package insert.

Variable* - Refer to package insert.

CAPROSYNâ„¢http://www.syneture.com/imageServer.aspx?contentID=5472&contenttype=image/jpeg

CAPROSYNâ„¢ suture's quick absorption, durable polymer material and monofilament construction provides smooth passage through tissue, better approximation or ligation, and minimized potentiating of infection. Patients can experience less discomfort during healing, less wound complications and a faster recovery.

CAPROSYNâ„¢ suture delivers a much faster absorption rate than other USP synthetic absorbable sutures-only 56 days! CAPROSYNâ„¢ has superior strength out-of-package and provides secure wound approximation for 10 days.

The addition of the violet dye provides good surgical visualization especially when working in a deep cavity.

CAPROSYNâ„¢ sutures offer advantages over gut suture including lower tissue reactivity, superior handling and predictable strength and absorption profiles.

http://www.syneture.com/imageServer.aspx?contentID=8814&contenttype=image/jpeg

Features and Benefits

CAPROSYNâ„¢ suture is a monofilament synthetic absorbable suture that provides short-term tensile strength combined with the benefits of rapid absorption. CAPROSYNâ„¢ is positioned for OB/GYN, Urology, general subcuticular closure, Plastics and other specialties where the benefits and rapid absorption may play a significant role in post operative success.

Features

Benefits

56 days mass loss

Rapid absorption of Caprosynâ„¢ may reduce post operative reactivity

Monofilament construction

Reduced tissue drag and less trauma to tissue

Excellent pliability

Ease of handling and tying

Low Tissue Reactivity

Synthetic suture is inherently less reactive and may reduce the chances of scarring and adhesions

Suture Integrity

CAPROSYNâ„¢ suture maintains integrity after multiple passes