Wednesday, November 23, 2011

Nonabsorbable Sutures Q & A

What are three of the most important characteristics to consider in nonabsorbable sutures?

There are several different characteristics that are important to consider when choosing sutures. The first is the durability of the suture itself, some will eventually breakdown and stop providing wound support while others are a more permanent option. The second important characteristic is the ease of use of the suture material and the third is the resistance to infection and the minimal amount of tissue reaction that occurs when the sutures are used.

Can some types of nonabsorbable sutures be broken down by the body over time? Which options provide little or no risk for this to occur?

Not all nonabsorbable sutures will last indefinitely within the human body. Silk, which is considered a nonabsorbable, will typically be fully broken down in the body within approximately two years. This can vary based on the type of tissue the suture is in, blood flow to the area, infections and the reaction of the body to the presence of a foreign body.

The most permanent type of sutures are those made of stainless steel. These sutures will have a consistent tensile strength throughout their implantation in tissue in the human body. Polyblend fibers, which are synthetic, are another highly durable option. These nonabsorbable sutures, like stainless surgical steel, will not be absorbed by the body and there is no evidence that a significant change in tensile strength occurs after the procedure. It is considered to be up to 15 times stronger than steel on a weighted basis and highly resistant to abrasion.

What are the advantages of monofilament nonabsorbable sutures over multifilament options?

Monofilament nonabsorbable sutures are more uniform in shape and diameter and also have a smoother surface than the multifilament options which are braided or twisted. The variation is extremely small but may provide an increased risk of bacterial migration along the suture or in pulling instead of a smooth flow through the tissue during the suturing process. This is a minimal concern in most cases but for specific procedures it may be an important consideration.

What is the biggest difficulty in working with surgical stainless steel nonabsorbable sutures?

Stainless steel sutures are used in a variety of different surgical procedures. It is most commonly seen in areas where wound support is required for extended periods of time in very high stress areas of the body. Thoracic surgery, neurosurgery and for surgical procedures involving orthopedics it is considered the best possible suture.

The stiffness and lack of suppleness of stainless steel sutures make them difficult to work with, especially in limited spaces where the suture material can crimp or twist on itself during the suturing process. There is also the risk that this type of suture may have a reaction in some patients and cannot be used in areas of the body or in patients where there are other metals or alloys present. These can occasionally cause electrolyte reactions in the body when the metals or alloys are in close proximity to each other.

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