User:Navy Malinois/Surgical suture

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Surgical suture, also known as a stitch, or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of thread. There are many different types of sutures that differ by needle shape and size and thread material and characteristics. Selection of surgical suture should be determined by the characteristics and location of the wound or the specific body tissues being approximated.

Professionals must consider the tensile strength of the specific suture thread needed to efficiently hold the tissues together depending on the mechanical and shear forces acting on the wound as well as the thickness of the tissue being approximated. One must also consider the elasticity of the thread and ability to adapt to different to the tissue as well as the memory of the thread material which lends to ease of use for the operator. Different suture characteristics lend way to differing degrees of tissue reaction and the operator must select a suture that minimizes the tissue reaction while still keeping with appropriate tensile strength.

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Materials:

Suture material is often broken down into absorbable thread versus non-absorbable thread. Which is further delineated into synthetic fibers versus natural fibers (mont reid). Another important distinction among suture material is whether it is comprised of monofilament or polyfilament. (Byrne)

Monofilament versus polyfilament: monofilament fibers have less tensile strength, but create less tissue trauma and and are more appropriate with delicate tissues where tissue trauma can be more significant such as small blood vessels. polyfilaments are composed of multiple fibers and are generally greater in diameter with greater tensile strength(Byrne)

Absorbable

Absorbable sutures are either degraded via proteolysis or hydrolysis and should not be utilized on body tissue that would require greater than two months of tensile strength. It is generally used internally during surgery or to avoid the need for another procedure in patient with low probability of returning for suture removal. (Mont Reid)

Natural absorbable : includes Plain catgut, Chromic catgut and Fast catgut which are all produced from the collagen extracted from bovine intestines. They are all polyfilaments which have different degradations times ranging from 3-28 days. (need citation for a chart). This material is often used for body tissue with low mechanical or shearing force and rapid healing time (Byrne)

Synthetic absorbable : includes Polyglactic acid, Polyglycolic acid, Poliglecaprone,  Polydioxanone and Polytrimethylene carbonate. Among these are monofilaments, polyfilaments and braided sutures. In general synthetic materials will keep tensile strength for longer due to less local tissue inflammation Mont ried

Non-absorbable

These sutures hold greater tensile strength for longer periods of time and are not subject to degradation. They are appropriate for tissues with a high degree of mechanical or shear force (tendons, certain skin location). They also supply the operator with greater ease of use due to less memory.

Natural non-absorbable : includes surgical silk which is derived protein from silkworms and coated to minimize friction and water absorption.

synthetic non-absorbable : includes nylon, polypropylene and surgical steel all of which are monofilaments with great tensile strength.

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