Tissue sutures

Hu W, Huang ZM (2010) Biocompatibility of braided poly(L-lactic acid) nanofiber wires applied as tissue sutures. Polym Int 59(1 ) 92—99... 

Related to the suture is the tissue suture anchor, used to attach soft tissue to bone. The anchor is embedded into bone and the suture can be used to reattach the soft tissue. The most common anchor is polylactide-based and is used in shoulder repair. 

The first synthetic polyglycoHc acid suture was introduced in 1970 with great success (21). This is because synthetic polymers are preferable to natural polymers since greater control over uniformity and mechanical properties are obtainable. The foreign body response to synthetic polymer absorption generally is quite predictable whereas catgut absorption is variable and usually produces a more intense inflammatory reaction (22). This greater tissue compatibihty is cmcial when the implant must serve as an inert, mechanical device prior to bioresorption. 

Polylactic Acid. Polylactic acid (PLA) was introduced in 1966 for degradable surgical implants. Hydrolysis yields lactic acid, a normal intermediate of carbohydrate metaboHsm (23). PolyglycoHc acid sutures have a predictable degradation rate which coincides with the healing sequence of natural tissues. 

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. 

Although silk and cotton are classified as nonabsorbable sutures, these do lose strength gradually in living tissue and slowly break up after long periods of implantation (18). The USP specifications for Class I nonabsorbable sutures (silk or synthetic fibers) are shown in Table 4. 

Despite the universal use of sutures for wound closure, there is a need to utilize adhesives instead, because of their ease of use and the reduced risk of infection. Alkyl cyanoacrylate adhesives have been studied extensively for this use, and a significant amount of research has been performed to evaluate their interaction with living tissue [40,41 J. They have been approved for external use only, because of concerns with the fact that the polymers do not readily biodegrade and can cause inflammation around the area to which it was applied. However, these concerns are reduced for -butyl cyanoacrylate, as compared to the ethyl cyanoacrylate. There is even some evidence that their use as liquid sutures actually reduces the rate of infection around the healing wound or surgical incision [42J. 

The extent to which these new tissue adhesives and hemostats will influence surgical procedures can be seen in the following analogy. An effective carpenter cannot create a masterpiece without a saw to cut wood, nails to ensure local fixation of separate pieces of wood, and glue to cause broad surface apposition between wood surfaces. Similarly, the surgeon presently uses a scalpel to cut and divide tissues as well as a suture to create local fixation of tissues, but until... 

Quinn, J., Drzewiecki, A., Li, M., Stiell, I., Sutcliffe, T., Elmsiie, T. and Wood, W., A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Ann. Emerg. Med., 22, 1130-1135 (1993). 

Local infiltration anesthesia is die injection of a local anesthetic druginto tissues. This type of anesfliesia may be used for dental procedures, die suturing of small wounds, or making an incision into a small area, such as that required for removing a superficial piece of tissue for biopsy. 

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... 

PGA was one of the very first degradable polymers ever investigated for biomedical use. PGA found favor as a degradable suture, and has been actively used since 1970 [45 -7]. Because PGA is poorly soluble in many common solvents, limited research has been conducted with PGA-based drug delivery devices. Instead, most recent research has focused on short-term tissue engineering scaffolds. PGA is often fabricated into a mesh network and has been used as a scaffold for bone [48-51], cartilage [52-54], tendon [55, 56], and tooth [57]. 

SUTURE KIT SURGICAL INCL ADSON TISSUE FORCEPS WITH TEETH DISR20S 6515013093551 PG 14527 ... 

Adverse tissue reactions, to sutures, 24 218 Advertising, technical service personnel and, 24 343 Advicor, 5 146... 

Tissue paper products, 13 129-130 Tissue plasminogen activator (t-PA) bioseparation from mammalian cell culture, 3 821-826 peptide map, 3 841, 842 selling price, 3 817t Tissue reactions, to sutures, 24 218 Tissue-type plasminogen activator (t-PA) and hemostatic system, 4 89 human, use as thrombolytic agent,... 

Synthetic blood vessels and patches for soft tissue regeneration surgical sutures for use in vascular, cardiac, general surgery and orthopaedic procedures. .. 

Suture size has some correspondence to the tissue being bound together with thinner tissues like the face requiring thinner sutures. Thinner sutures are also required for facial surgery to limit scar formation. 

---