{"id":6416,"date":"2020-05-20T13:58:27","date_gmt":"2020-05-20T10:58:27","guid":{"rendered":"https:\/\/www.boztibbi.com\/veteriner-cerrahisinde-kullanilan-dikis-materyalleri-nelerdir\/"},"modified":"2024-09-04T14:24:43","modified_gmt":"2024-09-04T11:24:43","slug":"suture-materials-used-in-veterinary-surgery","status":"publish","type":"post","link":"https:\/\/www.boztibbi.com\/en\/suture-materials-used-in-veterinary-surgery\/","title":{"rendered":"Suture Materials Used in Veterinary Surgery"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text]Sutures are used in the surgical operations to connect the injured tissues or tissue incisions. With today\u2019s 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 <a href=\"https:\/\/www.boztibbi.com\/veteriner-cerrahisinde-kullanilan-sutur-dikis-teknikleri\/\">here<\/a> 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.[\/vc_column_text][vc_column_text]We can considered veterinary sutures under 2 separate titles:<\/p>\n<p><strong>1. Absorbable Sutures<\/strong><\/p>\n<ul>\n<li>Catgut<\/li>\n<li>Polyglycolic acid (PGA)<\/li>\n<li>Polydioxanone (PDS)<\/li>\n<li>Poly Glycolide Caprolactone (PGCL)<\/li>\n<\/ul>\n<p><strong>2. Non-absorbable sutures<\/strong><\/p>\n<ul>\n<li>Silk<\/li>\n<li>Nylon<\/li>\n<li>Polypropylene (PP)<\/li>\n<li>Stainless steel wire<\/li>\n<li>Polyester (PET)<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h3>Absorbable Veterinary Surgery Sutures<\/h3>\n<p>Absorbable sutures lose tensile strength in the following 60 days after implementation. These sutures are absorbed by the defence system of the body <span style=\"color: #3366ff;\">(1, 2)<\/span> and almost all of these sutures lead to partial tissue reaction <span style=\"color: #3366ff;\">(1)<\/span>. 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 <span style=\"color: #3366ff;\">(2)<\/span>.<\/p>\n<h4><strong>Catgut<\/strong><\/h4>\n<p>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 <span style=\"color: #3366ff;\">(1, 2, 3)<\/span>. Catgut is a naturally absorbable multifilament suture obtained from lamb intestine submucosa or cattle intestine serosa <span style=\"color: #3366ff;\">(2, 5, 6, 7, 11, 12, 3)<\/span>. Jejunum and ileum are used as intestine <span style=\"color: #3366ff;\">(7)<\/span>. This is the most common suture in the veterinary surgery even though synthetic sutures are developed today <span style=\"color: #3366ff;\">(6)<\/span>. After implemented to the tissues, the suture can be degraded in enzymatic way, absorbed by phagocytosis and always cause an inflammatory reaction <span style=\"color: #3366ff;\">(2, 6, 8)<\/span>. It is known that catguts lead to more intense tissue reaction in cats more than dogs <span style=\"color: #3366ff;\">(1)<\/span>. 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 <span style=\"color: #3366ff;\">(6)<\/span>. the suture is completely absorbed between 10-14 days <span style=\"color: #3366ff;\">(1, 9)<\/span>. 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 <span style=\"color: #3366ff;\">(2, 3, 6, 7, 9, 10)<\/span>. At the end of the processing with chromic salts, the intermolecular bonds increase and the suture gains a good strength <span style=\"color: #3366ff;\">(6)<\/span>. Chrome catguts lose the entire tensile strength in 21-28 days after implantation <span style=\"color: #3366ff;\">(2)<\/span>. The complete absorption duration varies between 20-40 days. It is reported that catguts are absorbed faster in case of infection <span style=\"color: #3366ff;\">(1, 2, 6)<\/span>, tissues with high blood flow <span style=\"color: #3366ff;\">(1, 6)<\/span> and tissues with organ enzymes such as pancreas and intestine <span style=\"color: #3366ff;\">(1) (6)<\/span>. Additionally, catguts have capillary properties. However, this suture is used in gastrointestinal and urogenital system, parenchymatous organs <span style=\"color: #3366ff;\">(11)<\/span>, vein ligatures, muscle and facia sutures <span style=\"color: #3366ff;\">(3)<\/span>. The skin and nerve tissue use of catguts are contraindicated <span style=\"color: #3366ff;\">(11)<\/span>. Due to hydrophobic properties, the knots tend to get lose since the water is absorbed <span style=\"color: #3366ff;\">(1, 2 , 6)<\/span>. Therefore, 3 or more knots are necessary <span style=\"color: #3366ff;\">(1, 11)<\/span> and the sutures cut after the knot must be longer than the other types of sutures <span style=\"color: #3366ff;\">(1, 6)<\/span>. To soften the hard structure, some firms pack this suture in 85% alcohol <span style=\"color: #3366ff;\">(6.10)<\/span>.<\/p>\n<h4><strong>Polyglycolic acid (PGA)<\/strong><\/h4>\n<p>This is a multifilament and braided synthetic polyester suture material made from polymeric hydroxy acetic acid <span style=\"color: #3366ff;\">(1, 2, 11)<\/span>. Polyglycolic acid sutures are coated with polycaprolate for easier use and easier implementation on the tissues <span style=\"color: #3366ff;\">(1, 2 )<\/span> 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 <span style=\"color: #3366ff;\">(1, 2, 9)<\/span>. 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 <span style=\"color: #3366ff;\">(2)<\/span>. The suture loses the 33-40% of the tensile strength on the 7th day after implantation <span style=\"color: #3366ff;\">(15, 9, 10)<\/span>, 65-80% on the 14th day <span style=\"color: #3366ff;\">(10, 1, 9, 11)<\/span>, 95% on the 28th day and completely resorbed on 90-120 day via hydrolysis <span style=\"color: #3366ff;\">(1, 9, 10, 11)<\/span>. Polyglycolic acid sutures are suitable for intestine anastomosis, C-section operations, hernia and tissues that do not require long-term support <span style=\"color: #3366ff;\">(2)<\/span>.<\/p>\n<h4><strong>Polydioxanone (PDS)<\/strong><\/h4>\n<p>This is a monofilament absorbable synthetic suture <span style=\"color: #3366ff;\">(2, 6, 11)<\/span> formed from paradioxanone polymer <span style=\"color: #3366ff;\">(2, 13)<\/span>. 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 <span style=\"color: #3366ff;\">(6, 10)<\/span>. PDS is successfully used for sterile and infected urine in the dog\u2019s bladder <span style=\"color: #3366ff;\">(1)<\/span>. Since polydioxanone is hard, manipulation is hard <span style=\"color: #3366ff;\">(1, 5, 10, 11)<\/span> and knot security is low <span style=\"color: #3366ff;\">(1, 9, 10)<\/span>. 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 <span style=\"color: #3366ff;\">(1, 9)<\/span>.<\/p>\n<h4><strong>Poly Glycolide Caprolactone (PGCL)<\/strong><\/h4>\n<p>Poly Glycolide Caprolactone (PGCL) is a monofilament absorbable suture made from epsilon caprolactone and glycolide co-polymer <span style=\"color: #3366ff;\">(2)<\/span>. Although it has a monofilament structure, handling, pliability and know security are good <span style=\"color: #3366ff;\">(1, 2, 10, 14)<\/span>. This suture leads to minimal reaction on the tissues <span style=\"color: #3366ff;\">(3, 14, 15)<\/span>. The suture can easily pass through the tissues and do not have capillarity <span style=\"color: #3366ff;\">(2)<\/span>. 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 <span style=\"color: #3366ff;\">(12)<\/span>. 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 <span style=\"color: #3366ff;\">(10)<\/span>. This suture is recommended for linea alba <span style=\"color: #3366ff;\">(2)<\/span>, subcutaneous <span style=\"color: #3366ff;\">(12)<\/span> and soft tissue closure and various ligature applications in cats <span style=\"color: #3366ff;\">(2, 12)<\/span>.[\/vc_column_text][vc_column_text]<\/p>\n<h3>Non-Absorbable Veterinary Surgery Sutures<\/h3>\n<p>Non-absorbable sutures preserve the tensile strength for more than 60 days after the implantation <span style=\"color: #3366ff;\">(18, 36, 37)<\/span> and are not degraded as significant level <span style=\"color: #3366ff;\">(2)<\/span>. However, silk and multifilament nylon sutures among non-absorbable sutures lose the majority of the tensile strength 4-6 weeks after the implantation <span style=\"color: #3366ff;\">(4)<\/span>. 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:<\/p>\n<h4><strong>Silk<\/strong><\/h4>\n<p>This suture is produced from silkworm larva and it consists of protein fibres and braided structure <span style=\"color: #3366ff;\">(9, 11, 13)<\/span>. The original colour of silk is white. However, the suture is dyed to black or green colour to be easily visible during the operation <span style=\"color: #3366ff;\">(6)<\/span>. Silk suture that leads to intense tissue reaction <span style=\"color: #3366ff;\">(2, 9, 15)<\/span> has significant capillary property due to multifilament structure <span style=\"color: #3366ff;\">(2, 9, 11)<\/span>. However, the silk suture is coated with wax or silicon to decrease the capillary property <span style=\"color: #3366ff;\">(5)<\/span>. On the other hand, this suture must be used for infected scars <span style=\"color: #3366ff;\">(1, 6, 9, 11)<\/span> and epithelium coated hollow organs <span style=\"color: #3366ff;\">(1)<\/span> 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 <span style=\"color: #3366ff;\">(2, 6, 11)<\/span>. Silk sutures have the lowest tensile strength among the sutures that are used today <span style=\"color: #3366ff;\">(9)<\/span>. Although it is classified as non-absorbable suture, 50% of the tensile strength is lost in 1 year after the implantation <span style=\"color: #3366ff;\">(2)<\/span> and the suture is entirely absorbed in approximately 2 years <span style=\"color: #3366ff;\">(1, 2, 10)<\/span>. 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 <span style=\"color: #3366ff;\">(2)<\/span>.<\/p>\n<h4><strong>Nylon<\/strong><\/h4>\n<p>Nylon sutures are thermoplastic derivatives that contain hexamethylenediamine and adipic acid amine. These sutures have monofilament and multifilament forms<span style=\"color: #3366ff;\"> (1, 2)<\/span>. The most common type is monofilament form <span style=\"color: #3366ff;\">(6)<\/span>. 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 <span style=\"color: #3366ff;\">(10)<\/span>. Nylon sutures have the perfect elasticity property <span style=\"color: #3366ff;\">(9)<\/span>. Monofilament sutures are hard to handle and have low knot security <span style=\"color: #3366ff;\">(1, 10)<\/span>. Additionally, the thing ones may cut the tissue <span style=\"color: #3366ff;\">(10)<\/span>. Multifilament sutures are easy to handle but these have capillary properties <span style=\"color: #3366ff;\">(1)<\/span> and lead to more tissue reaction <span style=\"color: #3366ff;\">(10)<\/span>. In case of infection, monofilament nylon sutures can be easily used <span style=\"color: #3366ff;\">(6)<\/span>. When used in serosa and synovial cavities, the suture end inside the tissue might lead to irritation<span style=\"color: #3366ff;\"> (1)<\/span>.<\/p>\n<h4><strong>Polyester (PTFE)<\/strong><\/h4>\n<p>This suture is made from polyethylene terephalate. This suture is stronger than silk and catgut <span style=\"color: #3366ff;\">(2)<\/span> but have weak know security <span style=\"color: #3366ff;\">(1)<\/span>. Polyester causes trauma when passed through the tissues <span style=\"color: #3366ff;\">(10)<\/span>. Polyester sutures are coated with polybutylene to reduce the trauma and to make the manipulation easier <span style=\"color: #3366ff;\">(2)<\/span>.<\/p>\n<h4><strong>Polypropylene (PP)<\/strong><\/h4>\n<p>This is a monofilament non-absorbable suture made from polypropylene stereo isomer. The tensile strength is lower than other synthetic non-absorbable sutures <span style=\"color: #3366ff;\">(4)<\/span>. The suture has low handling and knot safety but high memory <span style=\"color: #3366ff;\">(21, 27, 28, 39) (1, 2, 9, 11)<\/span>. 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 <span style=\"color: #3366ff;\">(10)<\/span>. This suture has plasticity property <span style=\"color: #3366ff;\">(1, 10)<\/span>. It is commonly used in vascular surgery <span style=\"color: #3366ff;\">(1)<\/span>.<\/p>\n<h4><strong>Stainless Steel Wire<\/strong><\/h4>\n<p>These are molybdenum, nickel and chromium alloy <span style=\"color: #3366ff;\">(10)<\/span>. It is a biologically inert material <span style=\"color: #3366ff;\">(2, 15)<\/span>. These sutures have monofilament and multifilament forms <span style=\"color: #3366ff;\">(6, 11)<\/span>. This suture is more durable than all other sutures <span style=\"color: #3366ff;\">(5, 6, 11)<\/span>. The suture does not have capillary property <span style=\"color: #3366ff;\">(1)<\/span>. This suture is commonly used in orthopaedic surgery <span style=\"color: #3366ff;\">(2)<\/span> and tendon and ligament repair <span style=\"color: #3366ff;\">(1)<\/span>. Additionally, it can be used in contaminated and infected wounds <span style=\"color: #3366ff;\">(10)<\/span>. The manipulation is hard <span style=\"color: #3366ff;\">(6, 11)<\/span> and the operator\u2019s glove might be punctured during manipulation <span style=\"color: #3366ff;\">(6)<\/span>. Additionally, this suture tends to cut the tissues <span style=\"color: #3366ff;\">(1, 2, 6, 11)<\/span> and might break when bend too much <span style=\"color: #3366ff;\">(1)<\/span>. It is not elastic and knotting is hard <span style=\"color: #3366ff;\">(11)<\/span>. Veterinary surgeons rarely use this suture <span style=\"color: #3366ff;\">(6)<\/span>.[\/vc_column_text][vc_separator][vc_column_text]<\/p>\n<h4>Bibliography<\/h4>\n<p>[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(1)<\/span> Niles J, Williams J <strong> (1999): Suture Materials and Patterns<\/strong>, In Practice, 21:308-20[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(2)<\/span> Tan R, Bell R, Dowling B, Dart A <strong>(2003) Suture Materials; Composition and Applications in Veterinary Wound Repair,<\/strong> Aust Vet J, 81(3):140-45[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(3)<\/span> Hickman J, Houlton JEF, Edwards B <strong>(1995): An Atlas of Vet Surg, 3 nd Ed,<\/strong> Blackwell Science, Cambridge[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(4)<\/span> Smeak, DD <strong>(1990): Selection and Use of Currently Available Suture Material, (in) Current Techniques in Small Animal Surgery, MJ Bojrab (Editor),<\/strong> chapter 3, 3<sup>nd<\/sup> Ed, Lea &amp; Febiger, Philadelphia[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(5)<\/span> Stashak, TS <strong>(1991): Equine Wound Management,<\/strong> Lea &amp; Febiger, Malvern, Pennsylvania[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(6)<\/span> Turner AS, McWra\u0131th CW <strong>(1995): Techniques in Large Animal Surgery 2nd Ed,<\/strong> Lea &amp; Febiger, Philadelphia[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(7)<\/span> Chu, CC\u00a0 <strong>(2001): Textile-Based Biomaterials for Surgical Aplications. (in) Polymeric Biomaterials Second Edition Revised and Expanded, S. Dumitriu, (Edit\u00f6r)<\/strong> Chapter 19, Marcel Dekker, New York.[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(8)<\/span> Sherbeeny, AM <strong>(2004): Needdles, Sutures and Knots Part III: Spesific Suture Materials,<\/strong> ASJOG, 1:167-70[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(9)<\/span> Moy RL, Lee A, Zalka A <strong>(1991): Commonly Used Suture Materials in Skin Surgery,<\/strong> Am Fam Physician, 44(6):2123-8[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(10)<\/span> Terhune, M <strong>(2002): Materials for wound closure,<\/strong> <a href=\"http:\/\/www.emedicine.com\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.emedicine.com<\/a>[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(11)<\/span> Knecht CD, Allen AR, Will\u0131ams DJ, Jonhson <strong>(1987): Fundamental Techniques in Vet Surg, 3nd Ed,<\/strong> WB Saunder Company, Philadelphia[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(12)<\/span> Henderson, RA <strong>(2005). The Veterinarian&#8217;s Suture Guide<\/strong> <a href=\"http:\/\/www.vetmed.auburn.edu\" target=\"_blank\" rel=\"noopener noreferrer\">http:\/\/www.vetmed.auburn.edu<\/a>[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(13)<\/span> Mc Ilwraith CW, Turner AS <strong>(1987): Equine Surgert Advanced Techniques, Lea&amp; Febiger,<\/strong> Malvern, Pennsylvania[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(14)<\/span> Sylvestre A, Wilson J, Hare J <strong>(2002): A Comparison of 2 Different Suture Patterns for Skin Closure of Canine Ovariohysterectomy,<\/strong> Can Vet J, 43:699\u2013702[\/vc_column_text][vc_separator][vc_column_text]<span style=\"color: #3366ff;\">(15)<\/span> Greenwald D, Albear P, Gotlieb L <strong>(1994): Mechanical Comparison of 10 Suture Materials Before and After in Vivo \u0130ncubation,<\/strong> J Surg Res, 56: 372-7[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text]Sutures are used in the surgical operations to connect the injured tissues or tissue incisions. With today\u2019s 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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":5858,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[182],"tags":[184,183,185,123,126,186],"class_list":["post-6416","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sutures","tag-absorbable-suture","tag-catgut","tag-non-absorbable-sutures","tag-surgical-suture","tag-suture","tag-veterinary-suture"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Suture Materials Used in Veterinary Surgery - Boz Medical<\/title>\n<meta name=\"description\" content=\"Sutures are used in the surgical operations to connect the injured tissues or tissue incisions. 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