Suture is a surgical suture material with different types and dimensions depending on the size, type or region of the wound to offer temporary or permanent wound support by ensuring the control of bleeding, to support wound healing, prevent infection, connect the damaged tissue for planned or unplanned wound damages that might be due to a surgical intervention or a trauma. (3)

Sutures which are known as the surgical sutures are divided into two groups as absorbable and non-absorbable surgical sutures as well as monofilament and multifilament sutures. In our previous article, we have talked about monofilament sutures; in this article, we will talk about the advantages and disadvantages of multifilament sutures which are also known as braided sutures, where these sutures are used and the chemical raw materials in their structures.

What Are Multifilament Sutures?

Multifilament sutures which can have natural or synthetic structures consists of braiding or wrapping multiple filaments. These braided surgical sutures have two types depending on braid or wrapping type; if two filaments are combined and braided, these are called twisted and if more than two filaments are braided, these are called braided. These have capillary property and although the capillary property is reduced with coating, this property cannot be completely eliminated.

What Are the Advantages of Multifilament Sutures?

Multifilament surgical sutures are more durable than monofilament sutures, they are easy to use and they do not get lose easily due to high knot safety. (1) These sutures are flexible, strong, soft and bendable. Also, multifilament sutures have high resistance value and durable against wear. (3)

What Are the Disadvantages of Multifilament Sutures?

Multifilament sutures with absorbable and non-absorbable types are not suitable for wounds with high infection risk as the risk for microbial colonization is high for the sutured tissue. These sutures pass hard from the tissue; since the filaments are braided, there is an increasing friction coefficient as the multifilament suture passes from the tissue and therefore, the damage and reaction risk for the tissue is high. (4) Special coating is used to minimize this problem, to make the passing from the tissue easier and decrease tissue damage. Generally, these sutures are preferred to connect the internal organ tissues after surgical interventions. (4) However, there might be exceptions and surgeons might prefer these sutures for surface tissue depending on the wound structure.

Which Raw Materials Are Used for Multifilament Sutures?

There are lots of different multifilament (braided) surgical sutures which include Polyglycolic acid (PGA), Poly Glycolide Lactic Acid (PGLA), Polyester (PET) and natural silk consisting of an organic polymer called fibroin.

What Is The Chemical Structure of Non-Absorbable Multifilament Sutures?

The chemical structure of the non-absorbable braided sutures include polyester raw material consisting of ethylene tetraflate as coating material. An organic polymer called fibroin is used for natural non-absorbable surgical sutures.

What Is The Chemical Structure of Absorbable Multifilament Sutures?

The chemical structure of the absorbable sutures include synthetic manufactured from 100% polyglycolic acid. For the special coating material of braided surgical filaments, a mixture of Calcium Stearate and Polycaprolactone or Poly (Glycolide Lactide) (30/70) is used. Fast absorbable braided sutures are degraded with gamma for fast hydrolysis/absorption and gamma radiation is used for the sterilization.

What Is The Chemical Structure of Antibacterial Absorbable Multifilament Sutures?

To prevent bacteria formation after connecting the tissue with surgical intervention, antibacterial multifilament (braided) surgical sutures can be preferred in some cases. Since the chance for braided surgical sutures to have microorganisms is higher than a monofilament suture consisting of a single suture, the absorbable sutures can be made antibacterial. To do that, chlorhexidine diacetate (CHA) agent which is a large spectrum anti-bacterial agent with no more than 60 mg/m in the chemical structure gives the antibacterial effect.

Bibliography

(1) Dereli, T . “SÜTÜR MALZEMELERİ VE SÜTÜR TEKNİKLERİ”. Güncel Dermatoloji Dergisi 1 (2016 ): 24-33

(2) Öğr. Gör. Öznur Özdinç (Gaziantep Üniversitesi): Ameliyat İpliklerinin Özellikleri | Properties of Suture Materials

(3) Şerife Daylan (Ankara Numune Eğitim ve Araştırma Hastanesi, Ankara – 2018): Sütur Materyalleri ve Diğer Kapatma Malzemeleri

(4) Desiree Ratner, MD Clinical Professor of Dermatology, NYU Langone Health. (2020): What are the differences between monofilament and multifilament sutures? https://www.medscape.com/

Any surgical filaments used for connecting or stitching blood vein ligation or tissues is called suture and the name of this term comes from Latin. Surgical sutures are divided into two groups as absorbable and non-absorbable sutures as well as monofilament and multifilament sutures. In this article, we will answer what is monofilament suture, what are the advantages and disadvantages, where are these sutures used and what are the structural properties?

What Are The Monofilament Suture Usage Areas?

Monofilament sutures are often used for open wounds such as contaminated wounds and irregular, uneven, recessed wound; traumatic wounds caused by a crushing tool or blunt trauma as well as for cosmetic purposes. (3, 4)

What Are the Advantages of Monofilament Sutures?

Monofilament sutures consist of single filament (twist), are not braided such as multifilament sutures, can easily pass from tissues due to low friction due to smooth texture as it consist of a single filament, causes minimum tissue trauma and causes less reaction. Since these are not braided, there are no gaps for bacteria formation and therefore, the risk for microbial colonization is extremely low. (1) Monofilament sutures with natural or synthetic structure have polypropylene, PDO, stainless steel wire and natural silk structure.

What Are the Disadvantages of Monofilament Sutures?

Since monofilament sutures consist of a single-row material, they have simple structure and have lower resistance. To give more detail, they have low know safety and lose most of their tension when help with a tool. When absorbable and non-absorbable types are compared, the half-life and resistance might differ. (2, 3)

What Is The Chemical Structure of Non-Absorbable Monofilament Sutures?

As mentioned above, non-absorbable monofilament sutures have polypropylene, PDO, stainless steel wire and natural silk structures. The materials in the chemical structures are synthetic linear polyolefin, polyvinylidene difluoride polymer, Nylon 6 or Nylon 6,6 or 100% Polytetrafluoroethylene consisting of from the stereoisomer of the isotactic crystal of polypropylene. An organic polymer called fibroin is in natural types. Stainless steel wire version is preferred for orthopaedic procedures such as abdominal wound closure, hernia or tendon operations.

What Is The Structure of Absorbable Monofilament Sutures?

As the name suggest, absorbable monofilament sutures are absorbed by the body within a certain time and disappear in the tissue; although the absorption time differs, the absorption duration is longer than braided multifilament sutures. The synthetic materials in the chemical structure are glycolide, co-caprolactone and 100% polydioxanone. The types that use animal-based raw materials use purified sheep small intestine submucosal fibrosis tissue.

What Is The Structure of Antibacterial Absorbable Monofilament Sutures?

The chemical structure of the antibacterial sutures that underwent a special sterilization process to avoid bacteria colonization on the sutured tissue when the tissues with surgical intervention is antibacterial due to Broad spectrum antibacterial agent chlorhexidine diacetate (CHA) with not more than 60mg/m2 in the chemical structure.

Bibliography

(1) Dereli, T . “SÜTÜR MALZEMELERİ VE SÜTÜR TEKNİKLERİ”. Güncel Dermatoloji Dergisi 1 (2016 ): 24-33

(2) Öğr. Gör. Öznur Özdinç (Gaziantep Üniversitesi): Ameliyat İpliklerinin Özellikleri | Properties of Suture Materials

(3) Şerife Daylan (Ankara Numune Eğitim ve Araştırma Hastanesi, Ankara – 2018): Sütur Materyalleri ve Diğer Kapatma Malzemeleri

(4) Prof. Dr. Sevgi ARAS (AÜTF – Geriatri Bilim Dalı): Yara Nedir? Tipleri, Evrelendirme

Sutures are used in the surgical operations to connect the injured tissues or tissue incisions. With today’s technological opportunities, it is possible to manufacture various suture products. Each of these sutures are preferred for different surgical operations depending on the suture properties. The support of the sutures in tissue recovery plays an important in veterinary surgery. Click here to learn more about veterinary surgery suture properties and click here to learn more about suture techniques. When choosing a suture, scar/incision conditions as well as physical, chemical, and biologic properties of the sutures should be considered. In this article, we will talk about the veterinary sutures.

We can considered veterinary sutures under 2 separate titles:

1. Absorbable Sutures

• Catgut
• Polyglycolic acid (PGA)
• Polydioxanone (PDS)
• Poly Glycolide Caprolactone (PGCL)

2. Non-absorbable sutures

• Silk
• Nylon
• Polypropylene (PP)
• Stainless steel wire
• Polyester (PET)

Absorbable Veterinary Surgery Sutures

Absorbable sutures lose tensile strength in the following 60 days after implementation. These sutures are absorbed by the defence system of the body (1, 2) and almost all of these sutures lead to partial tissue reaction (1). However, these sutures are degraded with non-enzymatic hydrolysis. In synthetic suture hydrolysis, polymer structure is degraded into monomer structure with the direct effect of the water and the monomer structure is metabolised into carbon dioxide with water. With these properties, synthetic sutures do not have visible effect on absorption rate in case of infection or inflammation (2).

Catgut

Most of the synthetic sutures are formed by polymerising the liquid resin; silk suture formed from natural fibres is formed by bending and catguts are formed by stratification and bending after creating stripe forms (1, 2, 3). Catgut is a naturally absorbable multifilament suture obtained from lamb intestine submucosa or cattle intestine serosa (2, 5, 6, 7, 11, 12, 3). Jejunum and ileum are used as intestine (7). This is the most common suture in the veterinary surgery even though synthetic sutures are developed today (6). After implemented to the tissues, the suture can be degraded in enzymatic way, absorbed by phagocytosis and always cause an inflammatory reaction (2, 6, 8). It is known that catguts lead to more intense tissue reaction in cats more than dogs (1). When a normal catgut is implemented to the tissue, the 50% of the tensile strength is lost on the 1st day and entire tensile strength is lost between day 3 and 7 (6). the suture is completely absorbed between 10-14 days (1, 9). Normal catgut is formed as chromium catgut by processing with chromic salts to increase the strength and to decrease the tissue reaction by increasing the degrading period (2, 3, 6, 7, 9, 10). At the end of the processing with chromic salts, the intermolecular bonds increase and the suture gains a good strength (6). Chrome catguts lose the entire tensile strength in 21-28 days after implantation (2). The complete absorption duration varies between 20-40 days. It is reported that catguts are absorbed faster in case of infection (1, 2, 6), tissues with high blood flow (1, 6) and tissues with organ enzymes such as pancreas and intestine (1) (6). Additionally, catguts have capillary properties. However, this suture is used in gastrointestinal and urogenital system, parenchymatous organs (11), vein ligatures, muscle and facia sutures (3). The skin and nerve tissue use of catguts are contraindicated (11). Due to hydrophobic properties, the knots tend to get lose since the water is absorbed (1, 2 , 6). Therefore, 3 or more knots are necessary (1, 11) and the sutures cut after the knot must be longer than the other types of sutures (1, 6). To soften the hard structure, some firms pack this suture in 85% alcohol (6.10).

Polyglycolic acid (PGA)

This is a multifilament and braided synthetic polyester suture material made from polymeric hydroxy acetic acid (1, 2, 11). Polyglycolic acid sutures are coated with polycaprolate for easier use and easier implementation on the tissues (1, 2 ) but the knot security is decreased with this coating. Compared to catgut, the tensile strength and knot security are better, the resorption duration is longer and the tissue reactions are lower (1, 2, 9). However, tensile strength is lower than other absorbable synthetic sutures. Since use in oral cavity and in case of infected urine (due to alkaline pH) increases the suture degradation rate, this suture is not suitable for these conditions (2). The suture loses the 33-40% of the tensile strength on the 7th day after implantation (15, 9, 10), 65-80% on the 14th day (10, 1, 9, 11), 95% on the 28th day and completely resorbed on 90-120 day via hydrolysis (1, 9, 10, 11). Polyglycolic acid sutures are suitable for intestine anastomosis, C-section operations, hernia and tissues that do not require long-term support (2).

Polydioxanone (PDS)

This is a monofilament absorbable synthetic suture (2, 6, 11) formed from paradioxanone polymer (2, 13). PDS is stronger than other synthetic absorbable sutures and absorbed slower. Therefore, this suture leads to less reaction on the tissues. This suture can be applied on contaminated scars or scars with infection risk (6, 10). PDS is successfully used for sterile and infected urine in the dog’s bladder (1). Since polydioxanone is hard, manipulation is hard (1, 5, 10, 11) and knot security is low (1, 9, 10). After implantation, the suture loses 26% of the tensile strength on the 14th day, 50% on the 28th day, 86% on the 59th day and the suture is completely absorbed 180 days after the implantation (1, 9).

Poly Glycolide Caprolactone (PGCL)

Poly Glycolide Caprolactone (PGCL) is a monofilament absorbable suture made from epsilon caprolactone and glycolide co-polymer (2). Although it has a monofilament structure, handling, pliability and know security are good (1, 2, 10, 14). This suture leads to minimal reaction on the tissues (3, 14, 15). The suture can easily pass through the tissues and do not have capillarity (2). This suture is more durable than the catgut at the beginning. However, the tensile strength decreases rapidly after implanted to the tissue. The tensile strength 14 days after the implantation is equal to or more tan catgut and chrome catgut (12). After the implantation, the undyed version loses 40% of the tensile strength on the 7th day, 70-80% on the 14th day and completely absorbed between 90 to 120 days (10). This suture is recommended for linea alba (2), subcutaneous (12) and soft tissue closure and various ligature applications in cats (2, 12).

Non-Absorbable Veterinary Surgery Sutures

Non-absorbable sutures preserve the tensile strength for more than 60 days after the implantation (18, 36, 37) and are not degraded as significant level (2). However, silk and multifilament nylon sutures among non-absorbable sutures lose the majority of the tensile strength 4-6 weeks after the implantation (4). Non-absorbable sutures are used for scars that require long-term support. While natural non-absorbable sutures tend to create significant tissue reaction, synthetic sutures lead to less tissue reaction. Common non-absorbable suture materials used in the veterinaries are:

Silk

This suture is produced from silkworm larva and it consists of protein fibres and braided structure (9, 11, 13). The original colour of silk is white. However, the suture is dyed to black or green colour to be easily visible during the operation (6). Silk suture that leads to intense tissue reaction (2, 9, 15) has significant capillary property due to multifilament structure (2, 9, 11). However, the silk suture is coated with wax or silicon to decrease the capillary property (5). On the other hand, this suture must be used for infected scars (1, 6, 9, 11) and epithelium coated hollow organs (1) due to its capillary property. Although synthetic sutures have the perfect biologic properties, silk suture is popular in veterinary surgery due to good manipulation and knotting capacities (2, 6, 11). Silk sutures have the lowest tensile strength among the sutures that are used today (9). Although it is classified as non-absorbable suture, 50% of the tensile strength is lost in 1 year after the implantation (2) and the suture is entirely absorbed in approximately 2 years (1, 2, 10). It is known that the suture might lead to ulcer when used in gastrointestinal system and stones when used in urinary system and gallbladder channels (2).

Nylon

Nylon sutures are thermoplastic derivatives that contain hexamethylenediamine and adipic acid amine. These sutures have monofilament and multifilament forms (1, 2). The most common type is monofilament form (6). The monofilament sutures lose the tensile strength in 2-3 years after implanting to tissues and multifilament sutures lose the tensile strength in 6 months (10). Nylon sutures have the perfect elasticity property (9). Monofilament sutures are hard to handle and have low knot security (1, 10). Additionally, the thing ones may cut the tissue (10). Multifilament sutures are easy to handle but these have capillary properties (1) and lead to more tissue reaction (10). In case of infection, monofilament nylon sutures can be easily used (6). When used in serosa and synovial cavities, the suture end inside the tissue might lead to irritation (1).

Polyester (PTFE)

This suture is made from polyethylene terephalate. This suture is stronger than silk and catgut (2) but have weak know security (1). Polyester causes trauma when passed through the tissues (10). Polyester sutures are coated with polybutylene to reduce the trauma and to make the manipulation easier (2).

Polypropylene (PP)

This is a monofilament non-absorbable suture made from polypropylene stereo isomer. The tensile strength is lower than other synthetic non-absorbable sutures (4). The suture has low handling and knot safety but high memory (21, 27, 28, 39) (1, 2, 9, 11). More knots are necessary to prevent the unknotting and the knots must be melted with thermocautery. Since the suture has low friction coefficient, it can easily pass through the tissues (10). This suture has plasticity property (1, 10). It is commonly used in vascular surgery (1).

Stainless Steel Wire

These are molybdenum, nickel and chromium alloy (10). It is a biologically inert material (2, 15). These sutures have monofilament and multifilament forms (6, 11). This suture is more durable than all other sutures (5, 6, 11). The suture does not have capillary property (1). This suture is commonly used in orthopaedic surgery (2) and tendon and ligament repair (1). Additionally, it can be used in contaminated and infected wounds (10). The manipulation is hard (6, 11) and the operator’s glove might be punctured during manipulation (6). Additionally, this suture tends to cut the tissues (1, 2, 6, 11) and might break when bend too much (1). It is not elastic and knotting is hard (11). Veterinary surgeons rarely use this suture (6).

Bibliography

(1) Niles J, Williams J (1999): Suture Materials and Patterns, In Practice, 21:308-20

(2) Tan R, Bell R, Dowling B, Dart A (2003) Suture Materials; Composition and Applications in Veterinary Wound Repair, Aust Vet J, 81(3):140-45

(3) Hickman J, Houlton JEF, Edwards B (1995): An Atlas of Vet Surg, 3 nd Ed, Blackwell Science, Cambridge

(4) Smeak, DD (1990): Selection and Use of Currently Available Suture Material, (in) Current Techniques in Small Animal Surgery, MJ Bojrab (Editor), chapter 3, 3^nd Ed, Lea & Febiger, Philadelphia

(5) Stashak, TS (1991): Equine Wound Management, Lea & Febiger, Malvern, Pennsylvania

(6) Turner AS, McWraıth CW (1995): Techniques in Large Animal Surgery 2nd Ed, Lea & Febiger, Philadelphia

(7) Chu, CC  (2001): Textile-Based Biomaterials for Surgical Aplications. (in) Polymeric Biomaterials Second Edition Revised and Expanded, S. Dumitriu, (Editör) Chapter 19, Marcel Dekker, New York.

(8) Sherbeeny, AM (2004): Needdles, Sutures and Knots Part III: Spesific Suture Materials, ASJOG, 1:167-70

(9) Moy RL, Lee A, Zalka A (1991): Commonly Used Suture Materials in Skin Surgery, Am Fam Physician, 44(6):2123-8

(10) Terhune, M (2002): Materials for wound closure, http://www.emedicine.com

(11) Knecht CD, Allen AR, Willıams DJ, Jonhson (1987): Fundamental Techniques in Vet Surg, 3nd Ed, WB Saunder Company, Philadelphia

(12) Henderson, RA (2005). The Veterinarian’s Suture Guide http://www.vetmed.auburn.edu

(13) Mc Ilwraith CW, Turner AS (1987): Equine Surgert Advanced Techniques, Lea& Febiger, Malvern, Pennsylvania

(14) Sylvestre A, Wilson J, Hare J (2002): A Comparison of 2 Different Suture Patterns for Skin Closure of Canine Ovariohysterectomy, Can Vet J, 43:699–702

(15) Greenwald D, Albear P, Gotlieb L (1994): Mechanical Comparison of 10 Suture Materials Before and After in Vivo İncubation, J Surg Res, 56: 372-7

For veterinary surgeons, correct material selection and correct suturing technique plays an important role for traumatic surgical operations. Just like animals, suturing is one of the indispensable and common surgical operations in animal anatomy. Veterinary surgeons apply special suturing techniques depending on the wound condition. Surgeons must be aware of the suture needle, thread, knots, strength, usage type to correctly close the wound of the individual undergoing a surgical operation. Click here to learn more about veterinary suture types, materials and properties before veterinary suture techniques.

Veterinary Suture Techniques

There are numerous suture techniques. Each suture technique depends on wound shape and depth. The most important purpose for suturing is to ensure fast recovery with minimum tissue reaction. Suture selection is highly critical for the wound or incision to heal sufficiently and on-time. The veterinary suturing suture techniques are listed below:

• Simple Suture
• Cross Suture
• Horizontal Mattress Suture
• Vertical Mattress Suture
• Halsted Suture
• Lembert Suture
• Gambee Suture
• Continuous Suture
• Subcutaneous Suture
• Ford Locking Suture
• Bag Ring Suture
• Chinese Finger Trap Suture

We have listed the most preferred suture techniques. You can click on all the techniques here to view the sutures with visuals and texts.

Simple Suture

Simple sutures are placed horizontally from right to left. The direction is the opposite for left-handed surgeons. The needle is handled by the needle holder, pressed to the opposite side of the wound 2-5 mm away from the edge of the tissue, taken above the skin and connected.

Figure 1 – Simple Suture Technique (1)

Cross Suture

This is a commonly preferred method by surgeons by creating a simple suture connected with a knot. The most important advantage is connecting the tissues tighter. Just like the simple suture, the first step is to enter subcutaneously to the opposite side of the wound from 2-5 mm away from the tissue. Then, the needle transits to the opposite side from the exit point and the first step is repeated and the suture is completed with a knot.

Figure 2 – Cross Suture Technique (1)

Horizontal Mattress Suture

In this method, the needle is subcutaneously pricked from 2-5 mm away from the tissue edge and taken out from the opposite site horizontally and a knot is formed. The pressure is applied to a larger area and tissue rupturing risk is minimised.

Figure 3 – Horizontal Mattress Suture Technique (1)

Vertical Mattress Suture

By using the needle holder, the needle is subcutaneously pricked 8-100 mm away on the opposite side and a knot is formed. This technique has stronger tension than horizontal mattress suture.

Figure 4 – Vertical Mattress Suture Technique (1)

Halsted Suture

This technique is similar to vertical suturing. But before making a knot, the suture is implanted parallelly to the incision region. Halsted suture looks like a dashed pattern because the wound edges are reversed.

Figure 5 – Halsted Suture Technique (1)

Lembert Suture

This technique is similar to mattress suture and preferred for repairing caveated organs. Since the adherence layer is submucosa, the suture must be adjusted not to enter the lumen and the suture must not be tightened too much. If the suture is tightened too much before the knot, the wounded tissue might turned upside down.

Figure 6 – Lembert Suture Technique (1)

Gambee Suture

This technique is often preferred in intestine repairs. The purpose to use this suture is to decrease mucosa eversion and serosa surface rupture of the intestine.

Figure 7 – Gambee Suture Technique (1)

Continuous Suture

If the incision is long, continuous suture technique is used. In this technique, instead of losing time with knotting after every suture, a long incision area is sutured in a short time. At the same time, the tensile strength on the suture can be more equally distributed around the tissue. One of the disadvantages of continuous suture technique is that if one of the cycles is lose or ruptures, the thread will disintegrate.

Figure 8 – Continuous Suture Technique (1)

Subcutaneous Suture

This suture is applied subcutaneously in simple and continuous pattern. The needle can enter horizontally or vertically. This technique is also called embedded suture due to application type. This technique is used for avoiding any suture marks on the tissue and to reduce scarring.

Figure 9 – Subcutaneous Suture Technique (1)

Ford Locking Suture

This type of suture which is applied with locking style required more suturing materials than other suture techniques. Locking technique makes the suture stronger against patient’s intervention or external interventions. This technique is preferred to prevent a suture material subjected to external intervention to damage the internal tissues.

Figure 10 – Ford Locking Suture Technique (1)

Bag Ring Suture

This technique is preferred to fix visceral logs, and percutaneous tubes to a vicus in gastronomic and cystostomy procedures.

Figure 11 – Bag Ring Suture Technique (1)

Chinese Finger Trap Suture

This is a technique consisting of a series of knots to fix a tube in subcutaneous sucking and discharge. If the tension on the tube increases when the tube is taken out, this suture prevents the tube to be taken out.

Figure 12 – Chinese Finger Trap Suture Technique (2)

Veterinary Suture Knot Techniques

Knotting is as important as suturing. Suture must be connected with a correct knot to avoid the suture to get lose, move, or damage the tissue. The veterinary suture knot techniques are listed below:

• Square Knot
• Sliding Knot
• Rounded Knot
• Surgical Knot
• Subcutaneous Knot

We have listed the most preferred knot techniques. You can click on all the techniques here to view the sutures with visuals and texts.

Figure 13 – Suture Knot Techniques – Square Knot, Sliding Knot, Rounded Knot, Surgical Knot (3)

Square Knot

This technique is the most common knot type and used for fixing most of the suture patterns.

Sliding Knot

Other than lower tension, this knot is similar to the square knot. The thread is hold facing upwards and suture is completed with sliding knot for tightening or loosening.

Rounded Knot

Rounded knot is a commonly preferred knotting technique. This knotting technique is fast and durable.

Surgical Knot

This technique created minimum tissue trauma. Surgical knot is asymmetrical. Therefore, a square knot is applied to the top for security.

Subcutaneous Knot

Subcutaneous or embedded knots are preferred to decrease the irritation that might be caused by the knots rubbing to the external tissue.

Figure 14 – Subcutaneous Knot Technique (3)

Bibliography

(1) Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.

(2) With permission from Baines S, Lipscomb V and Hutchinson T. (2012) Manual of Canine and Feline Surgical Principles, BSAVA Gloucester, p 289.

(3) veteriankey.com Suturing Techniques and Common Surgical Procedures, bağlantı

Absorbable suture is a commonly preferred surgical suture that is absorbed by the body with hydrolysis or enzymatic ways and discarded naturally after implementation. There is no need to remove the sutures with absorbable sutures. With this property, absorbable suture do not leave a foreign object trace in the body.

One of the most commonly used absorbable suture is glycolic acid polymer. These sutures preserve approximately 65% tension until post-operative 14th day. These sutures are used on subcutaneous soft tissues. These sutures have multifilament polyglactin structure and can preserve the tension until day 14-21. These sutures have multifilament polyglactin structure and continues to be tense for a long time (60-90 days). These sutures are preferred for wound closure that requires long-term suture tension.

With the development of absorbable suture and increased opportunities, biologic-based catguts are rarely used today. Catguts are replaced with synthetic polymer structured suture materials that lead to less tissue reaction, preserve the tension for longer time, have higher knot security and enables ease of use. Although catguts are rarely used, these sutures are still preferred in some surgical operations.

Absorbable Suture Usage Area

Absorbable suture are highly versatile due to their unique properties. This leads a wide range of usage areas for absorbable suture. Today, there are numerous absorbable suture types. It is possible to find multifilament and monofilament. Multifilament is formed by braiding multiple fibre thread. Monofilament sutures have single thread. You can read our monofilament and multifilament suture review from here. The main usage areas of absorbable suture are as follows:

• Gynaecology
• General surgery
• Ophthalmic surgery
• Urology
• Orthopaedic
• Tissue closure in paediatric surgery
• Skin closures
• Gastrointestinal surgery
• Ligatures
• Oral and maxillofacial surgery
• Veterinary
• Plastic surgery

Boz Medical Absorbable Sutures

Boz Medical as the first medical consumables manufacturer in Turkey manufactures absorbable suture with 70-years of experience and modern facilities that can be easily used. The company can manufacture 12 different types of absorbable suture including anti-bacterial, multifilament, monofilament and catgut. You can view Boz Medical absorbable suture from the table below.