is inferior to many other suture materials in strength and knot security. Silk should not be used in the lining epithelium of hollow viscera and should be avoided in contaminated wounds.
Poliglecaprone 25 (Monocryl) in rapid dispense packaging
Poliglecaprone 25 Poliglecaprone 25 (Monocryl) is a relatively new monofilament suture that is prepared from a copolymer of glycolide and E-caprolactone. Dyed and undyed forms are available. Progressive loss of tensile strength and eventual absorption occurs by means of hydrolysis, with the dyed form losing all its original strength by 21 days post-implantation and the undyed form by 28 days. Poliglecaprone elicits a minimal inflammatory reaction in tissues, is easy to handle (having lower memory than the other monofilament synthetic absorbables) and has good knot security.
NON-ABSORBABLE SUTURES Non-absorbable suture materials are not degraded during the healing process although they do become encapsulated with fibrous tissue and remain permanently within the tissue unless they are extruded or removed. They are designed for use where prolonged mechanical support is required until sufficient healing has occurred to maintain tissue apposition. Non-reactive non-absorbables can be buried within tissues or organs to support slow healing tissues. They do not need to be removed as they are generally well tolerated by the body. Silk Silk is available as a braided multifilament suture material (Mersilk), which may be coated to decrease its natural capillarity. Although classified as a non-absorbable, it slowly loses tensile strength and is absorbed within approximately two years of implantation. Silk is inexpensive and has excellent handling characteristics. However, it causes marked tissue reaction and
Nylon Nylon is available as both a monofilament (Ethilon, Dermalon) and multifilament (Surgilon, Supramid) suture material. It causes minimal tissue reaction and, when used in veterinary work, is regarded as permanent (although it loses 30 per cent of its original tensile strength by two years as a result of slow hydrolysis). The main disadvantages of nylon are its poor handling characteristics and knot security. The braided forms handle and knot better but suffer from inherent capillarity. Nylon should not be used within serosa or synovial cavities because buried sharp ends may cause
irritation. Polyester Polyester (Mersilene) is a braided multifilament suture material available in plain and coated forms. It is extremely strong and offers prolonged support for slow healing tissues. It has poor knot security and causes the most tissue reaction of any of the synthetic suture materials.
Polypropylene Polypropylene (Prolene) is a monofilament suture that has a lower tensile strength than nylon. It retains its strength on implantation, is not weakened by tissue enzymes and is the least thrombogenic suture. It is therefore frequently used in vascular surgery. Its disadvantages are its high memory and poor knot holding ability.
Polybutester Polybutester (Novafil) is a special type of polyester suture which possesses many of the advantages of both polypropylene and polyester. It has good tensile strength and knot security. Stainless steel Stainless steel is available as a monofilament or multifilament suture. It is biologically inert, non-capillary and has the highest tensile strength of all the suture materials. Its main use is in tendon and ligament repair. The disadvantages of stainless steel include its tendency to cut tissues, its poor handling characteristics (especially in knot tying) and relatively poor ability to withstand repeated bending without breaking. OTHER
* iI]0wl
il-4*1
AFVi Synthetics
Natural fibres* Silk (Mersilk; Ethicon)
Monofilament
Multifilament
Nylon 66 and nylon 6 (Ethilon; Ethicon) (Dermalon; Davis & Geck)
Polyester (Mersilene; Ethicon)
Linen
Polypropylene (Prolene; Ethicon)
Polybutester (Novafil; Davis & Geck) Stainless steel *
OPTIONS FOR TISSUE APPOSITION/
LGATION
All are multifilament
Nylon (Surgilon; Davis & Geck) (Supramid; Bayer) Stainless steel
Tissue adhesives Tissue adhesives have been used experimentally and clinically in the management of comeal lacerations, in the control of haemorrhage from the cut surface of parenchymatous organs, and for cutaneous skin incisions and skin grafts. The cyanoacrylates have been used most extensively. Tissue toxicity can be a problem, as can granuloma formation, wound infections when used in contaminated sites, delayed healing if the wound edges are separated, and poor adhesion on excessively moist
surfaces. 312
In Practice * J U N E 1 999