Dog dehydration symptoms
July 21, 2020
Wounds healing
August 27, 2020
Suture the animal wounds
How to suture animal wounds, choice of materials and their use
Sutures role in the wound repair process is to provide hemostasis and support for tissue healing .
Some tissues need support for few days only (e.g. muscle, subcutaneous tissue, skin), whereas others require weeks (fascia) or even months (tendon) to heal.
The ideal suture is easy to handle
reacts minimally with the tissue, inhibits bacterial growth, holds securely when knotted, resists shrinking in tissue, is non-capillary, non-allergenic, non-carcinogenic and absorbs with minimal reaction after the tissue has healed. Unfortunately, the so-called ideal suture does not exist. What the operator can do is to choose the best technique and tools. In veterinary practice, this is what we have available. Suture materials are classified as absorbable or non-absorbable, natural or synthetic, and monofilament or multifilament, according to their composition and structure.
Absorbable suture materials...
Absorbable suture materials are defined as materials that lose their tensile strength within 60 days of implantation. Natural materials are absorbed through enzymatic degradation, whilst newer synthetic absorbable sutures are absorbed through nonenzymatic hydrolysis.
The advantage of new synthetic sutures is that, during the process of non-enzymatic hydrolysis, absorption rates are not significantly affected by the presence of infection or inflammation.
Absorbable suture materials used in veterinary practice include: surgical gut, polyglactin 910, polyglycolic acid, poliglecaprone 25, polydiaxanone, polyglyconate and panacryl
...and the non-absorbable materials
Non-absorbable suture materials are those not significantly degraded after implantation and are used where extended wound support is required. Natural fibers tend to invoke significant inflammatory reactions, thus the preference for synthetic non-absorbable sutures. Care should be taken when using multifilament non-absorbable materials due to their inherent capillarity. Non-absorbable suture materials used in veterinary surgery include: silk, polybutester, polyester, nylon, polypropylene and stainless steel.
Monofilament sutures are made of a single strand of material. They have less tissue drag than multifilament sutures and do not have interstices that may harbor bacteria.
Mono and multifilament
Multifilament sutures generally consist of several strands of suture that are twisted or braided together.
About the needle, its choice is based upon tissue type, location, accessibility of tissue and size of suture material. The needle should be of the smallest size possible to penetrate the tissue, yet long
enough to penetrate both sides.
Lastly the knot, it is the weakest part of the suture. In general, square knots are used because they are the most secure.
Choosing the appropriate suture is based on suture characteristics, tissue requirements and surgeon’s preferences. When selecting suture, the general objective is to choose a suture that can hold together the tissues that have been separated until healing has occurred.
General recommendations for small animal veterinary surgeons regarding suture selection in different tissues are:
| Tissue | Suture material | Usp (Suture size) | Surgical needle |
|---|---|---|---|
| Skin | Polyamide Polypropylene Poliglecaprone 25 Polyglytone 6211 Poliglecaprone 25 |
2-0 to 4-0 | Cutting or reverse cutting |
| Subcutaneous tissue | Polyglactin 910 Polyglycolic acid Lactomer 9-1 Polydioxanone |
2-0 to 4-0 | Taper |
| Linea alba & fascia | Polyglyconate Polypropylene Polyglactin 910 Polyglytone 6211 Polyglycolic acid |
1 to 3-0 | Taper or Reverse cutting |
| Muscles | Glycomer 631 Polydioxanone Lactomer 9-1 |
2-0 to 3-0 | Taper |
| Tendons | Polyglyconate Polypropylene Poliglecaprone 25 Glycomer 631 |
1 to 3-0 | Taper-cut |
| Hollow viscous organs | Polydioxanone Polyglyconate Glycomer 631 |
2-0 to 5-0 | Taper |
| Parenchymal organs | Polyglyconate Polydioxanone Polyglactin 910 Lactomer 9-1 Polyglycolic acid |
2-0 to 5-0 | Blunt |
| Blood vessels (ligation) | Polydioxanone Polyglyconate Glycomer 631 Poliglecaprone 25 |
0 to 4-0 | Taper |
| Oral and Pharyngeal Cavity | Polydioxanone Polyglyconate |
3-0 to 4-0 | Taper |
Fonti
1-Stefanos Kladakis et al., “Choosing sutures in small animal surgery”, Journal of Dairy, Veterinary & Animal Research ; 2014
2- RHH TAN et al., “Suture materials: composition and applications in veternary wound repair”, Aust Vet J; 2003
