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TABLE 1 Major Commercially Available Polymeric Sutures

Suture type

Generic chemical structure

Construction11

Representative Major

Sterilization commercial clinical method* product (manufacturer) use

Natural materials Catgut Silk

Synthetic absorbable Poly(glycolic acid) Poly(glycolide-co-lactide)

Po!y( p-dioxanone) Poly(glycolide-co-trimethylene carbonate)

Synthetic nonabsorbable Polyibutylene tereph-

thalate) Poly(ethylene tereph-

thalate) Poly[p(tetramethylene ether) terephthalate-co-tetramethylene] Polypropylene

Nylon 66

Protein Tw

Protein B

[—0CH2C02CH2C0—]90 B [0CH(CH3)C02CH(CH3)—CO—] ,0

COC6H4CO-]k

ETO/Rad. Catgut (D + G, Ethicon) ETO/Rad. Silk (D + G)

ETO Coated vicryl (Eth icon)'' Polysorb (USSC)1' ETO PDS (Ethicon) '

ETO/Rad. Miraline (Braun)

ETO/Rad. Ti.Cron (D+G) Surgidac (USSC) ETO/Rad. Novafil (D + G)

Prolene (Ethicon) Deklene (Deknatel) Surgipro (USSC) ETO/Rad. Dermalon (D + G) Ethilon (Ethicon) Monosof (USSC)

Ob/Gyn, urology

Cardiovascular

Vascular

General, Ob/Gyn General, Ob/Gyn

General, Ob/Gyn General, Ob/Gyn

Cardiovascular

Orthopaedics

Cardiovascular

Orthopaedics

Plastic/cuticular

Cardiovascular Vascular

Plastic/cuticular Ophthalmic

Note. Sources listed under Bibliography.

"Construction: Twisted (Tw); braid (B); monofilament (M).

'Sterilization method: Ethylene oxide (ETO); Gamma radiation (Rad.).

Dexon 11 package claims, Davis+Geck.

^Vicryl package claims, Ethicon.

"Polysorb package claims, United States Surgical.

'PDS package claims, Ethicon.

eMaxon package claims, Davis+Geck.

permanence of the material (absorbable or nonabsorbable), and the construction process (braided, monofilament) used. As shown in Table 1, the most popular natural materials used for sutures are silk and catgut (animal intestine). A fair amount of art and effort is required in both cases to reduce the raw material to the finished product. The synthetic materials are exclusively polymeric, except for fine-sized stainless steel sutures. All sutures, regardless of material or construction, require special surgical needles for delivery through tissue.

Approximately half of today's sutures are nonabsorbable and remain indefinitely intact when placed in the body. Common engineering polymers like polypropylene, nylon, poly(ethylene terephthalate), and polyethylene are used as sutures. Copolymers of these materials have also been used clinically. Absorbable sutures were commercially introduced by Davis + Geek in 1970 with poly(glycolic acid) (PGA) sutures and were followed by copolymers of glycolide and lactide from Ethicon and U.S. Surgical. More recently, novel absorbable polymers of polydioxanone and poly(glycolide-co-trimethylene carbonate) have been developed for surgical use (see Chapter 2.5 for additional information on resorbable materials).

Regardless of whether a suture is made from a natural or a synthetic material, or if it is absorbable or permanent, it must meet the strength requirements necessary to close a wound under a given clinical circumstance. Almost all suture products will be efficacious for minor wounds or for

table 2 Representative Mechanical Properties of Commercial Sutures
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