Changes

==Suture Materials==

==Suture Materials==

There are several different ways of categorising suture material, which can seem confusing.They can be categorised into absorbable/non absorbable or braided/monofilaments

There are several different ways of categorising suture material, which can seem confusing. They can be categorised into absorbable/non absorbable or braided/monofilaments

===Absorbable sutures===

===Absorbable sutures===

Absorbable materials include:

Absorbable materials include:

*Catgut; made from sheep intestinal submucosa or cattle intestinal serosa, catgut is highly antigenic and can cause a profound tissue reaction which make the rate of absorption unpredictable. Catgut is available coated in chromic salts which lessens this effect.

*Catgut; made from sheep intestinal submucosa or cattle intestinal serosa, catgut is highly antigenic and can cause a profound tissue reaction which make the rate of absorption unpredictable. Catgut is available coated with chromic salts which lessens this effect.

*Polyglactin 910 (‘Vicryl’) is commonly used in as a synthetic alternative to catgut, as it is far less antigenic. It looses '''45%''' of its tensile strength by '''day 14''' post operatively, and '''90%''' at '''28 days'''. Polyglactin 910 is coated to reduce tissue drag and to improve the material's knotting characteristics.  

*Polyglactin 910 (‘Vicryl’) is commonly used in as a synthetic alternative to catgut, as it is far less antigenic. It looses '''45%''' of its tensile strength by '''day 14''' post operatively, and '''90%''' at '''28 days'''. Polyglactin 910 is coated to reduce tissue drag and to improve the material's knotting characteristics.  

*‘Vicryl Rapide’ is a modified polyglactin 910 that has 70% less tensile strength than ‘Vicryl’ and is used mostly when an absorbable suture is required for skin closure.  

*‘Vicryl Rapide’ is a modified polyglactin 910 that has 70% less tensile strength than ‘Vicryl’ and is used mostly when an absorbable suture is required for skin closure.  

===Non absorbable sutures===  

===Non absorbable sutures===  

*Silk (e.g. ‘Mersilk’) is a natural fibre that does degrade and is absorbed, but this occurs so slowly that the material is classified as non absorbable. It does induce considerable tissue reaction, and has significant capillary action, so can never be used in the presence contamination or etablished infection. Tt is mainly used for ligatures, and is available in a coated form to reduce the capillary action of the fibre. Knot security can be a problem with this material.  

*Silk (e.g. ‘Mersilk’) is a natural fibre that does degrade and is absorbed, but this occurs so slowly that the material is classified as non absorbable. It does induce considerable tissue reaction, and has significant capillary action, so can never be used in the presence contamination or established infection. It is mainly used for ligatures, and is available in a coated form to reduce the capillary action of the fibre. Knot security can be a problem with this material.  

*Nylon (‘Ethilon’) is used predominantly for skin sutures as it has a high tensile strength, but the material's ‘memory’ – where the suture reverts back to the packaging shape – makes it hard to handle and knot security is poor.

*Nylon (‘Ethilon’) is used predominantly for skin sutures as it has a high tensile strength, but the material's ‘memory’ – where the suture reverts back to the packaging shape – makes it hard to handle and knot security is poor.

*Polypropylene (‘Prolene’) is similar to nylon, but the material flattens when knotted which improves knot security. It induces little reaction once placed and is used for vascular surgery or when placing meshes in large uncontaminated wounds.  

*Polypropylene (‘Prolene’) is similar to nylon, but the material flattens when knotted which improves knot security. It induces little reaction once placed and is used for vascular surgery or when placing meshes in large uncontaminated wounds.  

*Stainless steel is mainly used in haemostatic clips or skin staples to facilitate rapid wound closure. It is strong but fatigues easily. Stainless steel is available as a flexible suture material but it is difficult to use - it is indicated when a protracted time for tissue healing is required such as cases of significant wound breakdown in vital structures such as the linea alba.

*Stainless steel is mainly used in haemostatic clips or skin staples to facilitate rapid wound closure. It is strong but fatigues easily. Stainless steel is available as a flexible suture material but it is difficult to use - it is indicated when a protracted time for tissue healing is required such as cases of significant wound breakdown in vital structures such as the linea alba.

*Tissue adhesives (‘Vetbond’, ‘Vetseal’) are indicaed for the repair of small partial thickness wounds and some 'small furry' surgeries. The glue should be applied to a dry wound with adequate haemostasis as it polymerises quickly on contact with moisture. '''Adhesives are contra-indicated in the eye area''' because of the risk of accidental application into the eye.

*Tissue adhesives (‘Vetbond’, ‘Vetseal’) are indicated for the repair of small partial thickness wounds and some 'small furry' surgeries. The glue should be applied to a dry wound with adequate haemostasis as it polymerises quickly on contact with moisture. '''Adhesives are contra-indicated in the eye area''' because of the risk of accidental application into the eye.

===Monofilament sutures===  

===Monofilament sutures===  

===Braided sutures===  

===Braided sutures===  

Multifilament or braided suture materials are comprised of several strands of material twisted together and coated to give them greater handling characteristics with good knot security and reduced tissue drag. They are '''contra-indicated in contaminated or infected tisues''' as  bacteria can easily become established within the braided material where they remain undeected by the immune system.

Multifilament or braided suture materials are comprised of several strands of material twisted together and coated to give them greater handling characteristics with good knot security and reduced tissue drag. They are '''contra-indicated in contaminated or infected tissues''' as  bacteria can easily become established within the braided material where they remain undetected by the immune system.

==Suture Material sizes==

==Suture Material sizes==