What are Antibacterial Vicryl Sutures Made of and What are Their Absorbable Suture Properties

Synthetic absorbable sutures offer the strength needed for a wide range of applications, from abdominal and chest wound closure to ophthalmic and plastic surgery. Once such example is the Antibacterial Vicryl Suture, which is a synthetic, absorbable, sterile, surgical suture. It is a copolymer made from ninety percent glycolide and ten percent L-lactide. Coated Vicryl PlusAntibacterial Suture is coated with a mixture composed of equal parts of a copolymer of glycolide and lactide (polyglactin 370) and calcium stearate. Coated Vicryl Plus Antibacterial suture contains IRGACARE MP, which is one of the purest forms of the broad spectrum antibacterial agent triclosan.

Coated Vicryl Plus Antibacterial suture offers protection against bacterial colonization of the suture. In vivo studies demonstrate that Coated Vicryl Plus Antibacterial suture has a zone of inhibition that is effective against the disease causing organisms that most often cause surgical site infection  Staphylococcus aureus, methicillin resistant Staphylococcus aureus, Staphylococcus epidermidis, methicillin resistant staphylococcus epidermidis. In vivo studies demonstrate that Vicryl Plus Antibacterial suture has no adverse effect on normal wound healing. Coated Vicryl Plus Antibacterial suture performs and handles the same and has the same dependable construction as Coated Vicryl suture. In vivo testing by surgeons demonstrates the same excellence in performance and handling.

The suture is available in the market in two forms: When it is not dyed (naturally in a beige hue) and when it is dyed. The dyed form comes in violet color. Coated Vicryl  Plus suture is indicated for use in general soft tissue approximation and or ligation requiring medium support, except for ophthalmic, cardiovascular and neurological tissues. Frequent uses include general closure, bowel, orthopedic, and plastic surgery. Coated Vicryl Plus Antibacterial suture retains approximately seventy five percent of the original tensile strength at two weeks post implantation. At three weeks, approximately fifty percent of the original strength is retained. At four weeks, approximately twenty five percent of the original strength is retained. All of the original tensile strength is lost by five weeks post implantation. Absorption of Coated Vicryl Plus Antibacterial Suture is fundamentally complete between fifty six and seventy days.

Some of the major factors which can affect tensile strength loss and absorption rates are the type of suture, infection, and tissue sites. Plain gut generally absorbs more rapidly than chromic gut. Surgical gut is absorbed more rapidly in infected tissue than in non infected tissue. Surgical gut will absorb more rapidly in tissues where increased levels of enzymes are present, as in the secretions exhibited in the stomach, cervix and vagina. Physicians should consider the in vivo performance when selecting a suture for use in patients. . As with any foreign body, prolonged contact of any suture with salt solutions, such as those found in the urinary tracts may result in calculus formation.

Antibacterial Vicryl suture is only being made by Ethicon Inc. at this time. All Ethicon product codes related to Antibacterial  Vicryls begin with the prefix VCP.

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Uses of Plain Gut Fast Absorbable Suture and How They Differ From Plain Gut Suture

Fast absorbing surgical gut suture is a strand of collagenous material prepared from the sub mucosal layers of the small intestine of healthy sheep, or from the layers of the small intestine of healthy cattle. Fast absorbing surgical gut sutures are sterile and elicit only a slight to minimal tissue reaction during absorption. Fast absorbing surgical gut sutures differ from U.S.P. minimum strength requirements by less than thirty percent. Fast absorbing surgical gut sutures are intended for dermal suturing only. They should be utilized only for external knot tying procedures.

The results of implantation studies of fast absorbing surgical gut sutures in the skin of animals indicate that nearly all of its original strength is lost within approximately seven days of implantation. When surgical gut suture is placed in tissue, a moderate tissue inflammation occurs which is characteristic of the foreign body response to a substance. This is followed by a loss of tensile strength followed by a loss of suture mass, as the enzymatic digestive process dissolves the surgical gut. This process continues until the suture is completely absorbed. Many variable factors may affect the rate of absorption.  Data obtained from implantation studies in rats show that the absorption of these sutures is essentially complete by the twenty first to forty second post implantation day.

Users should be familiar with surgical procedures and techniques involving gut suture before using fast absorbing surgical gut suture for wound closure, as the risk of wound dehiscence may vary with the site of application and the suture material used. The use of this suture may be inappropriate in elderly, malnourished, or debilitated patients, or in patients suffering from conditions which may delay wound healing. As this is an absorbing material, the use of supplemental non absorbable sutures should be considered by the surgeon in the closure of sites which may undergo expansion, stretching or distention or which may require additional support. As an absorbable suture, fast absorbable surgical gut may act transiently as a foreign body. Acceptable surgical practice should be followed in the management of contaminated or infected wounds.

Adverse effects associated with the use of this fast absorbable surgical gut include wound dehiscence, variable rates of absorption over time (depending on such factors as the type of suture used, the presence of infection and the tissue site), failure to provide adequate wound support in closure of sites where expansion, stretching or distention occur, etc., unless additional support is supplied through the use of non-absorbable suture material, failure to provide adequate wound support in elderly, malnourished or debilitated patients or in patients suffering from cancer, anemia, obesity, diabetes, infection or other conditions which may delay wound healing, allergic response in patients with known sensitivities to collagen which may result in an immunological reaction resulting in inflammation, tissue granulation or fibrosis, wound suppuration and bleeding, as well as sinus formation, infection, moderate tissue inflammatory response characteristic of foreign body response, and calculi formation in urinary track when prolonged contact with salt solutions such as urine and bile occurs, and transitory local irritation at the wound site. 

Fast absorbing surgical gut sutures are only available in sizes 5-0 (metric size 1.5) and 6-0 (metric size 1.0) both with a PC-1 cutting needle which is thirteen millimeters in diameter. They are made by Ethicon and their item code numbers are 1915G for 5-0 and 1916G for 6-0.

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What are Antibacterial Vicryl Sutures Made of and What are Their Absorbable Suture Properties

Synthetic absorbable sutures offer the strength needed for a wide range of applications, from abdominal and chest wound closure to ophthalmic and plastic surgery. Once such example is the Antibacterial Vicryl Suture, which is a synthetic, absorbable, sterile, surgical suture. It is a copolymer made from ninety percent glycolide and ten percent L-lactide. Coated Vicryl Plus Antibacterial Suture is coated with a mixture composed of equal parts of a copolymer of glycolide and lactide (polyglactin 370) and calcium stearate. Coated Vicryl Plus Antibacterial suture contains IRGACARE MP, which is one of the purest forms of the broad spectrum antibacterial agent triclosan.

Coated Vicryl Plus Antibacterial suture offers protection against bacterial colonization of the suture. In vivo studies demonstrate that Coated Vicryl Plus Antibacterial suture has a zone of inhibition that is effective against the disease causing organisms that most often cause surgical site infection  Staphylococcus aureus, methicillin resistant Staphylococcus aureus, Staphylococcus epidermidis, methicillin resistant staphylococcus epidermidis. In vivo studies demonstrate that Vicryl Plus Antibacterial suture has no adverse effect on normal wound healing. Coated Vicryl Plus Antibacterial suture performs and handles the same and has the same dependable construction as Coated Vicryl suture. In vivo testing by surgeons demonstrates the same excellence in performance and handling.

The suture is available in the market in two forms: When it is not dyed (naturally in a beige hue) and when it is dyed. The dyed form comes in violet color. Coated Vicryl  Plus suture is indicated for use in general soft tissue approximation and or ligation requiring medium support, except for ophthalmic, cardiovascular and neurological tissues. Frequent uses include general closure, bowel, orthopedic, and plastic surgery. Coated Vicryl Plus Antibacterial suture retains approximately seventy five percent of the original tensile strength at two weeks post implantation. At three weeks, approximately fifty percent of the original strength is retained. At four weeks, approximately twenty five percent of the original strength is retained. All of the original tensile strength is lost by five weeks post implantation. Absorption of Coated Vicryl Plus Antibacterial Suture is fundamentally complete between fifty six and seventy days.

Some of the major factors which can affect tensile strength loss and absorption rates are the type of suture, infection, and tissue sites. Plain gut generally absorbs more rapidly than chromic gut. Surgical gut is absorbed more rapidly in infected tissue than in non infected tissue. Surgical gut will absorb more rapidly in tissues where increased levels of enzymes are present, as in the secretions exhibited in the stomach, cervix and vagina. Physicians should consider the in vivo performance when selecting a suture for use in patients. . As with any foreign body, prolonged contact of any suture with salt solutions, such as those found in the urinary tracts may result in calculus formation.

Antibacterial Vicryl suture is only being made by Ethicon Inc. at this time. All Ethicon product codes related to Antibacterial  Vicryls begin with the prefix VCP.

ACTICOAT Wound Dressing: A Wonder of Technology in a Silver Dressing

Technology has surely done wonders for the benefit of mankind and no less is the example of ACTICOAT Barrier dressing by Smith & Nephew, which is a state of the art barrier dressing. Its uniqueness lies in the way that is physical form has been manufactured. It has an external coating of silver coupled with nanocrystals that allows a wide variety of bacteria to be killed at a very fast pace. This usually takes less than half an hour, a much smaller amount of time in comparison to other forms of silver such as silver sulfadiazine or silver nitrate.  The nanocrystalline collating prevents the buildup of bacteria around the site of the wound. Underneath the silver coating is a core made of rayon and polyester that assists in controlling the level of moisture. Thus, the optimum moisture level for the healing of a wound is ensured. In addition to this, the polythene films contained in Acticoat Silver Dressing also have power over how much silver is to be released. This makes sure that as the silver ions are taken up; the right amount of silver is released over the right span of days.  The facilitation of the passage of silver through the dressing provides the patient with a most useful barrier for the protection against all forms of virus, bacteria and microbial fungi.

This silver based technology is not confined to being used only in wound dressings, but also works as an effective technology when used in implants and catheters to fight against infection. A catheter is a tube which issued to introduce liquids into a human body or to withdraw liquids from it, while an implant means to put something into a person’s body usually by means of a surgical operation. As burns are known to bring along severe risks of infection along with them, this technology of silver coating is deemed as a breakthrough the world over. ACTICOAT Barrier Dressing with Silcryst nanocrystals is an antimicrobial dressing that can be used for many kinds of wounds that include ulcers caused by pressure or diabetes, burns, recipient graft sites and cavity wounds.

The benefits of ACTICOAT are countless. Not only do they help reduce the risk of contamination, they also make sure that the barrier control is long lasting. Fortification against more than 150 disease causing organisms has been shown in-vitro. What is more, the pathogens that were included in the range were highly resistant strains such as Pseudomonas, and methicillin resistant Staphylococcus aureus, which have caused endless worries to many patients because of the ease with which they bypass the weakened immune systems. Another special characteristic of ACTICOAT barrier dressing is that yes it can be cut to any shape and size you want. This makes the application of the dressing to any body part very easy. Also, because of the controlled release of silver, you don’t have to keep on changing the dressing. This means that the wound is less exposed to the outside environment, and healing is not hampered.



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Properties of PDS II Absorbable Ethicon Suture and some of Its Surgical Use

Absorbable sutures are used to give support to wound edges temporarily, until they have healed enough to endure the regular stresses of the external environment. These sutures are prepared either from the collagen of healthy mammals or from synthetic polymers. Synthetic absorbable sutures are hydrolyzed. This is a process by which water slowly and eventually goes through the suture filaments. This leads to the breakdown of the suture's polymer chain. Hydrolysis results in a smaller degree of tissue reaction following implantation in comparison to the enzymatic action of natural absorbable materials. One example of a synthetic absorbable suture is the PDS II monofilament suture made by Ethicon, and which is deemed to be a wonderful addition to the suture market. 

PDS II is a monofilament that has resulted in a significant advance in suturing options. A monofilament suture is made of a single strand. It stops microorganisms from growing and living in the wound area, and it ties down smoothly. A suture can lose tensile strength rapidly and yet be absorbed slowly. It can maintain adequate tensile strength through wound healing, followed by rapid absorption. In any case, the strand is eventually completely dissolved, leaving no detectable traces in tissue. PDS II sutures are made up of the polyester polydioxanone. There are many advantages of using the PDS II suture. It combines the features of soft, pliable, monofilament construction with absorbability and extended wound support for up to six weeks. It causes only a slight tissue reaction. This material is widely acceptable and preferred for many types of soft tissue approximation, including pediatric cardiovascular, orthopedic, microsurgery and neural tissue, gynecologic, ophthalmic, plastic, digestive, and colonic surgeries.

Like other synthetic absorbable suture, PDS II sutures are absorbed in vivo through hydrolysis. Its tensile strength remains around seventy percent two weeks after the implantation, fifty percent at four weeks after implantation, and twenty five percent at six weeks after implantation. Absorption is negligible until about the 90th day after the operation and is for all intents and purposes complete within six months. The safety and effectiveness of PDS II sutures in microsurgery, neural tissue, and adult cardiovascular tissue have not been established. They may also be impregnated or coated with agents that improve their handling properties, and colored with a dye to increase visibility in tissue. PDS II sutures are available in clear or with a violet dye to increase visibility during a surgery.

PDS Plus Suture has an antibacterial agent added to it. This gives an additional advantage over the regular PDS II. It is indicated for use in soft tissue approximation, including use in pediatric cardiovascular tissue where growth is expected to take place and ophthalmic surgery. However, contact with cornea and sclera is a noted exception. PDS Plus Suture is not indicated in adult cardiovascular tissue, microsurgery, and neural tissue. These sutures are chiefly useful where the combination of an absorbable suture and wound support is indicated for a long period of time.  Up to six weeks is more often than not desirable.

The Need for Permanent Silk Sutures When Absorbable Sutures Will Not Do the Job

Stitches are one way of giving strength to a wound until the body's tissues are strong enough to take over. On the whole, the non-absorbable stitches are used where strength is needed for weeks or months for example abdominal wall wounds. Non absorbable sutures are defined by their resistance to eventual breakdown of living tissues. They are most useful in percutaneous closures. Non absorbable sutures are those which are not digested by body enzymes or hydrolyzed in body tissue. They are made from a variety of non biodegradable materials and are ultimately encapsulated or walled off by the body’s fibroblasts. Non absorbable sutures usually stay where they are buried within the tissues. When used for skin closure, they must be removed after the operation. One example of such sutures is the silk suture. It was first widely used as a suture material in the 1890s and was manufactured by Ethicon. Although silk is considered a non absorbable material, it is gradually degraded in tissue over two years.

It is a material formed from the protein fibers produced by silkworm larvae. Silk has excellent handling and knot-tying properties and is the standard to which all other suture materials are compared. It has a high knot security and tissue reactivity and low tensile strength. For many surgeons, surgical silk stands for the standard handling performance by which newer synthetic materials are judged, especially due to its superior handling characteristics. Silk filaments can be twisted or braided, the latter providing the best handling qualities. Raw silk is a continuous filament spun by the silkworm moth larva to make its cocoon. Cream or orange-colored in its raw state, each silk filament is processed to remove natural waxes and gum. It is degummed because it is of no help to the quality of braided surgical silk sutures. This allows for a tighter, more condensed braid which considerably enhances suture quality. After braiding, the strands are dyed, scoured and stretched, and then impregnated and coated with a mixture of waxes or silicone. Each of these steps is critical to the quality of the finished suturing and must be carried out in a precise order. Surgical silk is usually dyed black for easy visibility in tissue.

The silk sutures may be used in a range of applications such as exterior skin closure; to be removed after adequate healing has occurred. It can be used within the body cavity, where they will remain permanently encapsulated in tissue. It can also be applied in prosthetic attachment such as cases of defibrillators, pacemakers, drug delivery mechanisms. Silk also is useful as a transitory suture to raise or pull in tissues for improved visibility while a surgery is going on. Silk is very strong and handles nicely. Silk is unlikely to tear through even delicate tissues.

The choice of a particular suture material should be based on the patient, wound, tissue characteristics, and anatomic location. Understanding the various characteristics of available suture materials is important to make an educated selection.  Ethicon, Look, Sharpoint, & Syneture (Covidien) and are amongst the most respected silk suture makers in the world.


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The Generalities and Differences Between Vicryl Suture, Vicryl Rapide Suture, and Antibacterial Sutures

Dermatologic wounds can be closed by a range of methods. Although the skill and method of the surgeon are of utmost importance, the choice of wound closure materials also matters a lot. The rationale of these materials is to assist the wound closure until a wound is strong enough to withstand daily tensile forces and to enhance wound healing when the wound is most susceptible. Stitches are one of the ways of giving strength to a wound until the body's tissues are strong enough to take over. Absorbable stitches are used if the wounds are expected to heal within a week or two, for example subcutaneous tissues.

Vicryl sutures were first introduced in 1974. They were the second synthetic absorbable suture materials available. Like polyglycolic acid, polyglactin is braided and has similar handling and knot security properties. Vicryl is sometimes coated with another form of a compound called Polyglactin 370. This assists in knot tying and lessens tissue drag; however, this coating also reduces knot security and may cause surgeons to use more throws. Among the absorbable suture materials, Vicryl absorbable suture is a multifilament material.
There are many advantages of using Vicryl suture. The first tensile strength of polyglactin is a little greater than that of polyglycolic acid and is absorbed at a much faster rate. One of the special characteristics of Vicryl absorbable suture is that it retains sixty percent of its tensile strength at day fourteen after implantation and only eight percent of its original strength at day twenty eight. It is totally hydrolyzed in about sixty to ninety days. Tissue reactivity with polyglactin is small. Although used first and foremost as a buried suture, polyglactin has been used for percutaneous closures without unfavorable outcomes. This was coupled with cost savings. Polyglactin is accessible as an undyed or violet suture.

Two additional Polyglactin 910 sutures have been developed by Ethicon. Vicryl RAPIDE Suture which is composed of Polyglactin 910 that has been ionized with gamma rays to increase its rate of absorption. This product is useful as a buried suture in a wound needing restricted dermal support; it is wholly absorbed in thirty five days. The newest material is an antibacterial suture which is essentially Vicryl suture with additional antibacterial properties. The antibacterial agent used to coat the suture is known as triclosan. The Antibacterial Coated Vicryl provides decreased drag through tissue. For this reason, coated Vicryl sutures are used by some surgeons for the interior layer of bowel anastomosis; which is the joining together of two organs, usually hollow. Biocompatibility and implantation studies have shown this to be nontoxic and nonirritating. Managing, wound healing and absorption characteristics are of a similar standard as the Vicryl RAPIDE.

Few pediatric patients treated with the Vicryl antibacterial suture had pain on the first day after operation in comparison to those treated with the original Vicryl suture. This demonstrated a ratio of sixty-eight to eighty-nine percent. This suture may be helpful in wounds where there is a higher risk of infection.



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Monocryl Suture and its Absorbable Suture Characteristics

Absorbable suture materials are those that are broken down. The special characteristic of absorbable sutures is that they lose most of their tensile strength within sixty days after placement. These materials are broken down by hydrolysis but not by enzymes. Water penetrates the suture filaments and causes breakdown of the polymer chain. As a result, synthetic absorbable tends to evoke less tissue reaction than plain or chromic gut. They are used primarily as buried sutures to close the dermis and subcutaneous tissue and reduce wound tension. Today there are many synthetic absorbable suture materials made from polymers. One example of this is Monocryl suture which was manufactured by a company called Ethicon and that was also a part of the Johnson and Johnson Company. It was first introduced in the year 1993.

It is generally used for soft-tissue approximation and ligation. Monocryl sutures are composed of a compound known as poliglecaprone 25. This is a copolymer of glycolide and epsilon-caprolactone. A polymer means that it has recurring large molecules made from smaller molecules of the same kind. It is a monofilament material, but is very pliable in spite of this. It also has excellent pliability and provides easy handling and good knot security.  Monocryl suture comes dyed with gentian violet which makes it easier to see in surgery. It also comes undyed which is the preferred option for plastic surgery use since it’s not visibly seen in the healing process of the scars.

There are many advantages of using Monocryl suture. The dyed form of Monocryl retains sixty to seventy percent of its strength in the first week and thirty to forty percent in the second week, while the colored form of Monocryl retains fifty to sixty percent of its strength in the first week and twenty to thirty percent in the second week. These statistics show that it has a very high rate of absorption. It is essentially completely hydrolyzed by ninety to one hundred and twenty days. Monocryl has low tissue reactivity, maintains high tensile strength, and has a half-life of seven to fourteen days. When taken out of the package, it has a high degree of memory, or coil. One other benefit of monocryl sutures is that it is slippery, making it easier to pass than a braided suture. It has a consistency close to the nylon suture material. It is rarely used for percutaneous skin closure, and is not used in areas of especially high tension. One example of this is fascia.

Poliglecaprone is most useful as a buried suture in wounds in which prolonged dermal support is not essential. Similar to other monofilament sutures, poliglecaprone has minimal tissue drag and reactivity. The cost of poliglecaprone is comparable to that of polydioxanone. An antibacterial form of poliglecaprone is now available. The antibacterial agent is triclosan, which has been shown to inhibit colonization of the suture by methicillin-sensitive and methicillin-resistant S aureus and S epidermidis, Escherichia coli, and Klebsiella pneumoniae, even after direct in vivo challenge with bacteria. The tensile strength and absorption profile are not affected, however, and are similar to that of untreated poliglecaprone.