What are Antibacterial Vicryl Sutures Made of and What are Their Absorbable Suture Properties

Synthetic absorbable sutures offer the strength needed for a wide range of applications, from abdominal and chest wound closure to ophthalmic and plastic surgery. Once such example is the Antibacterial Vicryl Suture, which is a synthetic, absorbable, sterile, surgical suture. It is a copolymer made from ninety percent glycolide and ten percent L-lactide. Coated Vicryl Plus Antibacterial Suture is coated with a mixture composed of equal parts of a copolymer of glycolide and lactide (polyglactin 370) and calcium stearate. Coated Vicryl Plus Antibacterial suture contains IRGACARE MP, which is one of the purest forms of the broad spectrum antibacterial agent triclosan.

Coated Vicryl Plus Antibacterial suture offers protection against bacterial colonization of the suture. In vivo studies demonstrate that Coated Vicryl Plus Antibacterial suture has a zone of inhibition that is effective against the disease causing organisms that most often cause surgical site infection  Staphylococcus aureus, methicillin resistant Staphylococcus aureus, Staphylococcus epidermidis, methicillin resistant staphylococcus epidermidis. In vivo studies demonstrate that Vicryl Plus Antibacterial suture has no adverse effect on normal wound healing. Coated Vicryl Plus Antibacterial suture performs and handles the same and has the same dependable construction as Coated Vicryl suture. In vivo testing by surgeons demonstrates the same excellence in performance and handling.

The suture is available in the market in two forms: When it is not dyed (naturally in a beige hue) and when it is dyed. The dyed form comes in violet color. Coated Vicryl  Plus suture is indicated for use in general soft tissue approximation and or ligation requiring medium support, except for ophthalmic, cardiovascular and neurological tissues. Frequent uses include general closure, bowel, orthopedic, and plastic surgery. Coated Vicryl Plus Antibacterial suture retains approximately seventy five percent of the original tensile strength at two weeks post implantation. At three weeks, approximately fifty percent of the original strength is retained. At four weeks, approximately twenty five percent of the original strength is retained. All of the original tensile strength is lost by five weeks post implantation. Absorption of Coated Vicryl Plus Antibacterial Suture is fundamentally complete between fifty six and seventy days.

Some of the major factors which can affect tensile strength loss and absorption rates are the type of suture, infection, and tissue sites. Plain gut generally absorbs more rapidly than chromic gut. Surgical gut is absorbed more rapidly in infected tissue than in non infected tissue. Surgical gut will absorb more rapidly in tissues where increased levels of enzymes are present, as in the secretions exhibited in the stomach, cervix and vagina. Physicians should consider the in vivo performance when selecting a suture for use in patients. . As with any foreign body, prolonged contact of any suture with salt solutions, such as those found in the urinary tracts may result in calculus formation.

Antibacterial Vicryl suture is only being made by Ethicon Inc. at this time. All Ethicon product codes related to Antibacterial  Vicryls begin with the prefix VCP.

Prolene Suture and Overall Polypropylene Suture Characteristics, Knot Tying Tips, and Surgical Uses

Polypropylene is a compound that has an isostatic crystalline stereoisomer form. It is a hydrocarbon polymer that allows very less saturation. This is manufactured by a patented process which enhances pliability and handling. Thus, polypropylene monofilament sutures cannot be degraded or weakened by the action of tissue enzymes. They cause a negligible amount of tissue reaction and hold knots better than most other synthetic monofilament materials. One suture that is made of such a compound is Prolene suture.  It is made by Ethicon Inc., which is part of the Johnson and Johnson Company.

Prolene sutures are widely used in general, cardiovascular, plastic, and orthopedic surgery. Prolene sutures do not stick on to tissue and are therefore effective as a pullout suture. Prolene sutures are relatively biologically inert in comparison to other sutures, and offer strength, reliability and versatility that have been proven time and time again during surgeries. Prolene sutures are recommended for use where minimal suture reaction is desired. This can be in cases such as contaminated and infected wounds to minimize the sinus that can form later. Prolene sutures are also recommended for suture extrusion, i.e. forced out or squeezed through small openings. However, the few disadvantages include fragility, high plasticity, high expense, and difficulty of use compared to standard nylon sutures.

Certain patients may be sensitive to the compound that PROLENE suture is made up of, and might exhibit an immunological reaction resulting in inflammation, tissue granulation or fibrosis, wound suppuration and bleeding, as well as sinus formation.

The surgeon's or friction knot is recommended for tying Prolene polypropylene suture. The surgeon’s knot also may be performed using a one hand technique. The surgeon should avoid unnecessary tension when running down knots, to reduce the occurrence of surface fraying and weakening of the strand. Prolene sutures are available in the market in two forms. The undyed version is available in clear, and the dyed one comes in blue for better visibility.

Prolene has also become the mainstay of vascular anastomosis and had facilitated significant advances in cardiac and vascular surgery. It is used on both small vessels such as coronary artery bypasses and large vessels such as the aorta. It is used in obstetrical practice, during cesarean sections to suture the rectus sheath of the abdominal wall because it is non absorbable in nature and provides the sheath the due strength it deserves (rectus sheath is made up of various tendon extensions and muscle fibers and keeps up the strength of the abdominal wall, if it becomes weak the abdominal contents start producing symptoms of hernia) it stays there forever and is also often seen during repeat cesarean section as that of the previous section.

Polypropylene suture is also made by many different manufacturers as Look and Sharpoint, which have a much better overall cost than the brand name. Although Prolene suture is made by Ethicon, there are other suture makers that also manufacture it. In the case of Syneture (Covidien) their polypropylene suture product is called Surgipro. 

Please visit: SOS Medical for more information on these Sutures .

Uses of Plain Gut Fast Absorbable Suture and How They Differ From Plain Gut Suture

Fast absorbing surgical gut suture is a strand of collagenous material prepared from the sub mucosal layers of the small intestine of healthy sheep, or from the layers of the small intestine of healthy cattle. Fast absorbing surgical gut sutures are sterile and elicit only a slight to minimal tissue reaction during absorption. Fast absorbing surgical gut sutures differ from U.S.P. minimum strength requirements by less than thirty percent. Fast absorbing surgical gut sutures are intended for dermal suturing only. They should be utilized only for external knot tying procedures.

The results of implantation studies of fast absorbing surgical gut sutures in the skin of animals indicate that nearly all of its original strength is lost within approximately seven days of implantation. When surgical gut suture is placed in tissue, a moderate tissue inflammation occurs which is characteristic of the foreign body response to a substance. This is followed by a loss of tensile strength followed by a loss of suture mass, as the enzymatic digestive process dissolves the surgical gut. This process continues until the suture is completely absorbed. Many variable factors may affect the rate of absorption.  Data obtained from implantation studies in rats show that the absorption of these sutures is essentially complete by the twenty first to forty second post implantation day.

Users should be familiar with surgical procedures and techniques involving gut suture before using fast absorbing surgical gut suture for wound closure, as the risk of wound dehiscence may vary with the site of application and the suture material used. The use of this suture may be inappropriate in elderly, malnourished, or debilitated patients, or in patients suffering from conditions which may delay wound healing. As this is an absorbing material, the use of supplemental non absorbable sutures should be considered by the surgeon in the closure of sites which may undergo expansion, stretching or distention or which may require additional support. As an absorbable suture, fast absorbable surgical gut may act transiently as a foreign body. Acceptable surgical practice should be followed in the management of contaminated or infected wounds.

Adverse effects associated with the use of this fast absorbable surgical gut include wound dehiscence, variable rates of absorption over time (depending on such factors as the type of suture used, the presence of infection and the tissue site), failure to provide adequate wound support in closure of sites where expansion, stretching or distention occur, etc., unless additional support is supplied through the use of non-absorbable suture material, failure to provide adequate wound support in elderly, malnourished or debilitated patients or in patients suffering from cancer, anemia, obesity, diabetes, infection or other conditions which may delay wound healing, allergic response in patients with known sensitivities to collagen which may result in an immunological reaction resulting in inflammation, tissue granulation or fibrosis, wound suppuration and bleeding, as well as sinus formation, infection, moderate tissue inflammatory response characteristic of foreign body response, and calculi formation in urinary track when prolonged contact with salt solutions such as urine and bile occurs, and transitory local irritation at the wound site. 

 

Fast absorbing surgical gut sutures are only available in sizes 5-0 (metric size 1.5) and 6-0 (metric size 1.0) both with a PC-1 cutting needle which is thirteen millimeters in diameter. They are made by Ethicon and their item code numbers are 1915G for 5-0 and 1916G for 6-0.

Why is Ethibond Polyester Suture a Good Choice for Cardiovascular Surgery

There are several different suture materials used in precise and safe wound closure. Preferably, the choice of the suture material should be based on the biological interaction of the materials employed, the tissue configuration, and the biomechanical properties of the wound. An example of a suture that can be used in such cases is ETHIBOND suture. It belongs to the class of non absorbable sutures. It is a polyester suture that is composed of fibers of polyethylene terephthalate, which is a synthetic linear polyester resulting when glycol is reacted with a dibasic acid. The polyesters are long chains with a high molecular weight and aromatic rings that recur again and again as a vital part of the compound.  Examples of polyester sutures include Surgidac, TiCron made by Syneture Covidien and Ethibond Excel and Ethibond, made by Ethicon.

These polyester sutures were the first man-made braided suture material made known to last for an indefinite period in tissues. Their acceptance in surgery was confined to a small section in the beginning because the suture had a high coefficient of friction. This used to get in the way of the passage through tissue and hampered the construction of a knot. However, with the increase in scientific technology, it was soon learned that these sutures could be coated with a lubricant. Thus, ETHIBOND sutures gained wide acceptance in surgery. This coating markedly reduced the suture’s coefficient of friction, thereby assisting in knot construction and passage through tissue. All TiCron polyester sutures are coated with silicone, while the surface lubricant for Surgidac is Polybutylene adipate. Due to some surgeons liking to tie sutures with a high coefficient of friction, Surgidac sutures are also obtainable without a surface coating.

ETHIBOND Excel sutures are uniformly coated with polybutilate, a biologically non reactive and non absorbable compound that attaches itself to the braided polyester fiber strand. This was the first synthetic coating developed specifically as a surgical suture lubricant. The coating eases the passage of the braided strands through tissue and provides excellent pliability, handling qualities, and smooth tie down with each throw of the knot. Both the suture material and the coating are pharmacologically inactive. The sutures draw out negligible tissue reaction and retain their tensile strength in vivo for long periods of time. No significant change is known to occur in vivo. ETHIBOND Excel sutures are used primarily in cardiovascular surgery, for vessel anastomosis, and placement of prosthetic materials. Anastomosis is the joining together of two organs or vessels that are usually hollow, this is why any preferred brand of polyester suture will work beautifully in valve replacement procedures world wide.

ETHIBOND Excel is available in two forms, green when dyed and white when not dyed. ETHIBOND Excel sutures are also available attached to TFE polymer felt pledgets. These are small flat absorbent pads used to medicate, drain, save a wound from harm or serve to put off possible tearing of adjacent friable tissue. They are used on a regular basis in valve replacement procedures. This is to prevent the annulus from tearing when the prosthetic valve is seated and the sutures are tied. They are also used in situations where extreme deformity, distortion, or tissue destruction occurred.