Numerous different surgical<unk><unk>  exist. The following table compares some of the most common adsorbable<unk> s. Plain catgut Chromic catgut Polyglycolide (P.G.A.) Polydioxanone (PDS) Description Adsorbable biological<unk> <unk>  Plain is an adsorbable<unk>  made by twisting together strands of purified collagen taken from bovine intestines. The natural plain thread is precision ground in order to achieve a monofilament<unk> cter and treated with a glycerol containing solution. Plain is absorbed by enzymatic degradation. Adsorbable biological<unk> <unk>  Chromic is an adsorbable<unk>  made by twisting together strands of purified collagen taken from bovine intestines. Due to undergoing a ribbon stage chromicisation (treatment with chromic acid salts), the chromic offers roughly twice the stitch-holding time of plain catgut. Chromic is absorbed by enzymatic degradation. Note – catgut is no longer used in the UK for human surgery. A synthetic adsorbable<unk> <unk>  Braided synthetic adsorbable multifilament made of polyglycolic acid and coated with N-laurin and L-lysine, which render the thread extremely smooth, soft and knot safe. A synthetic adsorbable<unk> <unk>  Monofilament synthetic absorbable<unk> , prepared from the polyester, poly (p-dioxanone). Composition Natural purified collagen Natural purified collagen Polyglycolic acid Polyester and poly (p-dioxanone) Adsorption rate and tensile strength Strength retention for at least 7 days. Maintains strength for 10–14 days 84% at 2 weeks, 23% at 4 weeks 80% at 2 weeks, 44% at 8 weeks. Complete absorption within 200 days Structure Multifilament Multifilament Braided Monofilament Origin Bovine serosa surface finish. Made by twisting together strands of purified collagen taken from the small intestine of healthy ruminants Bovine serosa. The natural chromic thread is precision ground in order to achieve a monofilament<unk> cter and treated with a glycerol containing solution Synthetic Synthetic Treatment Treated with a glycerol-containing solution Treatment with a glycerol containing solution and chromic acid salts Coated with magnesium stearate Uncoated Type of adsorption Proteolytic enzymatic digestion complete by 90 days. Proteolytic enzymatic digestion complete in 70 days. Adsorption by enzymatic digestion and starts losing tensile strength on implantation from 18–21 days of catgut chromic Adsorption by hydrolysis complete between 60 and 90 days. Always predictable and reliable Wound support can remain up to 42 days, however tensile strength decreases to about 70% at 14 days and 25% at 42 days Tissue reaction Moderate. Plain catgut enjoys lower tissue reaction as compared to chromicised. Moderate. ? ? Thread color Straw Brown Violet and undyed Violet and clear Size available USP 6-0 (1 metric) to USP 5 (100 metric). USP 6-0 (1 metric) to USP 5 (100 metric). USP 6-0 (1 metric) to USP 2 (5 metric) USP 6-0 (1 metric) to USP 2 (5 metric) Sterilization Sterilizing fluid containing EO Sterilizing fluid containing EO E.O. gas. E.O. gas Advantages Very high knot-pull tensile strength, good knot security due to special excellent handling features Very high knot-pull tensile strength, good knot security due to special surface finish, improved smoothness due to the dry presentation of the thread, excellent handling features High initial tensile strength, guaranteed holding power through the critical wound healing period. Smooth passage through tissue, easy handling, excellent knotting ability, secure knot tying Tensile strength retention, guaranteed holding power Indications For all surgical procedures especially when tissues that regenerate faster are involved. General closure, ophthalmic, orthopedics, obstetrics/gynecology and gastro-intestinal tract surgery. For all surgical procedures, especially for tissues that regenerate faster. Subcutaneous, intracutaneous closures, abdominal and thoracic surgeries PDS is particularly useful where the combination of an adsorbable<unk>  and extended wound support is desirable, pediatric cardiovascular surgery, ophthalmic surgery Contraindications Not recommended for incisions that require the sustaining of the tissues for a prolonged period of time. Not recommended for an incision that requires sustaining of the tissues for a prolonged period of time. This<unk>  being adsorbable should not be used where extended approximation of tissue is required. This type of<unk>  being adsorbable is not to be used where prolonged approximation of tissues under stress is required and/ or in conjunction with prosthetic devices Precautions Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb the<unk> s at a higher rate. Cardiovascular surgery, due to the continued heart contractions. It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganisms. Avoid using where long term tissue approximation is needed. Absorption is faster in infected tissues It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganism. Cardiovascular surgery, due to the continued heart contractions. Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb this<unk>  at a higher rate. Special precautions should be taken in elderly patients and patients with history of anemia and malnutrition conditions. As with any<unk> <unk>  adequate knot security requires the accepted surgical technique of flat and square ties. The PDS<unk>  knots must be properly placed to be secure. Conjunctival and vaginal mucosal<unk> s remaining in place for extended periods may be associated with localized irritation. Subcuticular<unk> s should be placed as deeply as possible in order to minimize the erythema and induration normally associated with adsorption.
Suture materials comparison chart
Patient tracking system
Consensus error grid
Clinical decision support system
QUOROM flow chart
Clinical data management system
Procedure code
Ultrasound research interface