Absorbable sutures

Schneider, M.A.K., Element de suture absorbable et son procede de fabrication. French Patent, 1967 1,478,694. 

In order to achieve the desired fiber properties, the two monomers were copolymerized so the final product was a block copolymer of the ABA type, where A was pure polyglycoHde and B, a random copolymer of mostly poly (trimethylene carbonate). The selected composition was about 30—40% poly (trimethylene carbonate). This suture reportedly has exceUent flexibiHty and superior in vivo tensile strength retention compared to polyglycoHde. It has been absorbed without adverse reaction ia about seven months (43). MetaboHsm studies show that the route of excretion for the trimethylene carbonate moiety is somewhat different from the glycolate moiety. Most of the glycolate is excreted by urine whereas most of the carbonate is excreted by expired CO2 and uriae. 

Copolymers of S-caprolactone and L-lactide are elastomeric when prepared from 25% S-caprolactone and 75% L-lactide, and rigid when prepared from 10% S-caprolactone and 90% L-lactide (47). Blends of poly-DL-lactide and polycaprolactone polymers are another way to achieve unique elastomeric properties. Copolymers of S-caprolactone and glycoHde have been evaluated in fiber form as potential absorbable sutures. Strong, flexible monofilaments have been produced which maintain 11—37% of initial tensile strength after two weeks in vivo (48). 

Surgical sutures are sterile, flexible strands used to close wounds or to tie off tubular structures such as blood vessels. Made of natural or synthetic fiber and usually attached to a needle, they are available ia monofilament or multifilament forms. Sutures are classified by the United States Pharmacopeia (USP) (1) as either absorbable or nonabsorbable. The USP also categorizes sutures according to size (diameter) and Hsts certain performance requirements. Sutures are regulated by the Food and Dmg Administration (FDA) as medical devices under the Food, Dmg, and Cosmetics (FDC) Act of 1938, the Medical Device Act of 1976, and the Medical Device Reporting regulation of 1995. 

Sutures are required to hold tissues together until the tissues can heal adequately to support the tensions exerted on the wound duting normal activity. Sutures can be used ia skin, muscle, fat, organs, and vessels. Nonabsorbable sutures are designed to remain ia the body for the life of the patient, and are iadicated where permanent wound support is required. Absorbable sutures are designed to lose strength gradually over time by chemical reactions such as hydrolysis. These sutures are ultimately converted to soluble components that are then metabolized and excreted ia urine or feces, or as carbon dioxide ia expired air. Absorbable sutures are iadicated only where temporary wound support is needed. 

Absorbable sutures are classified by the USP into coUagen and synthetic sutures. Synthetic absorbable sutures are available as braids or monofilaments. Absorbable sutures are only intended for indications where temporary wound support is needed. 

Braided Synthetic Absorbable Sutures. Suture manufacturers have searched for many years to find a synthetic alternative to surgical gut. The first successful attempt to make a synthetic absorbable suture was the invention of polylactic acid [26023-30-3] suture (15). The polymer was made by the ring-opening polymerization of L-lactide [95-96-5] (1), the cycUc dimer of L-lactic acid. 

Polylactic acid sutures are slowly degraded by the foUowing hydrolysis reaction shown and can take years to be completely absorbed (16). These sutures were never commercialized. 

Lactomer suture is coated with a copolymer of caprolactone and glycoHde (3) and sold under the trade name Polysorb. It is claimed to retain approximately 30% of its out-of-package tensile strength three weeks after implantation and to be absorbed ia 56 to 70 days. 

Monofilament Synthetic Absorbable Sutures. Ethicon iatroduced the first monofilament synthetic absorbable suture ia 1984 when it marketed PDS polydioxanone (4) sutures. The polymer is produced by the bulk polymerisation of 2,5- -dioxanone. The suture is distributed under the trade name PDS 11. It is claimed to retain approximately 50% of its strength four weeks after implantation, 25% at six weeks, and to be absorbed within six months. 

Herrman, J. B., Kelly, R. J., and Higgins, G. A., Polygly-colic acid sutures, laboratory and clinical evaluation of a new absorbable suture material. Arch. Surg., 100, 1970. 

Polymers used in medicine fall into two main categories those that are sufficiently inert to fulfill a long-term structural function as biomaterials or membranes, and those that are sufficiently hydrolytically unstable to function as bioeradible materials, either in the form of sutures or as absorbable matrices for the controlled release of drugs. For the synthetic organic polymers widely used in biomedicine this often translates to a distinction between polymers that have a completely hydrocarbon backbone and those that have sites in the backbone that are hydrolytically sensitive. Ester, anhydride, amide, or urethane linkages in the backbone usually serve this function. 

The reduction of blood loss during or after surgical procedures where suturing or hgature is either impractical or impossible can often be accomphshed by the use of sterile, absorbable haemostats. These consist of a soft pad of sohd material packed around and over the wound which can be left in situ, being absorbed by body tissues over a period of time, usually up to 6 weeks. The principal mechanism of action of these is the ability to encourage platelet fiacture because of their fibrous or rough surfaces, and to act as a... 

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