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Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of Dundee
Absorbable sutures
may be used to hold wound edges in approximation temporarily, until they have healed sufficiently to withstand normal Stress These sutures are prepared either from the collagen of healthy mammals or from synthetic polymers. Some are absorbed rapidly, while others are treated or chemically structured to lengthen absorption time. They may also be impregnated or coated with agents that improve their handling properties, and colored
Absorbable sutures
Natural absorbable sutures are digested by body enzymes which attack and break down the suture strand. Synthetic absorbable sutures are hydrolyzeda process by which water gradually penetrates the suture filaments, causing the breakdown of the suture's polymer chain. Compared to the enzymatic action of natural absorbables, hydrolyzation results in a lesser degree of tissue reaction following implantation.
Absorbable sutures
During the first stage of the absorption process, tensile strength diminishes in a gradual, almost linear fashion. This occurs over the first several weeks post implantation. The second stage often follows with considerable overlap, characterized by loss of suture mass.
Absorbable sutures
Both stages exhibit leukocytic cellular responses which serve to remove cellular debris and suture material from the line of tissue approximation. The loss of tensile strength and the rate of absorption are separate phenomena. A suture can lose tensile strength rapidly and yet be absorbed slowly. or it can maintain adequate tensile strength through wound healing, followed by rapid absorption. In any case, the strand is eventually completely dissolved, leaving no detectable traces in tissue.
applications:
Exterior skin closure, to be removed after sufficient healing has occurred. Within the body cavity, where they will remain permanently encapsulated in tissue. Patient history of reaction to absorbable sutures, keloidal tendency, or possible tissue hypertrophy. Prosthesis attachment
plain or chromic. Both types consist of processed strands of highly purified collagen. The percentage of collagen in the suture determines its tensile strength and its ability to be absorbed by the body without adverse reaction. Non collagenous material can cause a reaction ranging from irritation to rejection of the suture.
Chromic gut
treated with a chromium salt solution to resist body enzymes, prolonging absorption time over 90 days. The process alters the coloration of the surgical gut from yellowish-tan to brown. Chromic gut sutures minimize tissue irritation, causing less reaction than plain surgical gut Tensile strength may be retained for 10 to 14 days, with some measurable strength remaining for up to 21 days.
MONOCRYL
At 7 days, undyed MONOCRYL suture retains approximately 50% to 60% of its original strength, And approximately 20% to 30% at 14 days post implantation. All of the original tensile strength of undyed suture is lost by 21 days. Absorption is essentially complete at 91 to 119 days. Dyed MONOCRYL suture retains 60% to 70% of its original strength at 7 days, reduced to 30% to 40% at 14 days.