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Suture Materials and Needles J Volume 10 | Issue 1 Article 5 1948 Suture Materials and Needles J. R. Olson Iowa State College Follow this and additional works at: https://lib.dr.iastate.edu/iowastate_veterinarian Part of the Other Veterinary Medicine Commons Recommended Citation Olson, J. R. (1948) "Suture Materials and Needles," Iowa State University Veterinarian: Vol. 10 : Iss. 1 , Article 5. Available at: https://lib.dr.iastate.edu/iowastate_veterinarian/vol10/iss1/5 This Article is brought to you for free and open access by the Journals at Iowa State University Digital Repository. It has been accepted for inclusion in Iowa State University Veterinarian by an authorized editor of Iowa State University Digital Repository. For more information, please contact [email protected]. Sllture Materials and N-eedles J. R. Olson, D.V.M.* In all surgery, both animal and human, the theoretical perfect can be much more the suture plays a basic role. To obtain closely attained. In order to make an in­ the best possible results the operator telligent selection, a thorough knowl­ should have a profound knowledge of the edge of the materials at hand must be had materials he uses. He should thoroughly as well as the character and condition of understand the effects of all sutures on the involved tissues. the tissues in order to select the proper All suture materials fall into two main material in each individual instance. categories: absorbable and non-absorb­ In our recorded history there is evi­ able. All absorbable sutures are of animal dence of the suture being in use some 4,000 origin and are so called because they are years ago. The ancient Egyptian and Arab absorbed by the body after they have surgeons employed the use of adhesive served their purpose. plasters made of linen and the string of Of the absorbable sutures now in use, the "kit" or dance masters fiddle. The catgut is probably the most popular. Cat­ kitstring was made of sheep intestine and gut is not a perfect suture by any means. is now called catgut, probably due to its Being of an animal origin it is naturally being confused with kitten string and later difficult to sterilize. Under heat and mois­ being changed to catgut. Early day sur­ ture it loses its tensile strength; there­ geons, however, preferred the use of cau­ fore, it is, of necessity, sterilized chemi­ tery and boiling oil to the ligature, and cally. Constant advancements are being their adhesive plaster to the suture. It made in the technic of its preparation, but was not until the nineteenth century that still there is an occasional report of a com­ the ligature came into popular usage, and plication due to contaminated gut. Cat­ only within the last 50 years has the gut when buried in tisue causes leucocy­ suture become universally accepted. tosis, infiltration, weakening, and local It.has been said that surgery improves necrosis. All of these factors are detri­ with the choice and preparation of suture mental to good wound healing but, by and materials. It is an unpleasant truth that large, they are overcast by the ability of today many operators have allowed them­ catgut to become resorbed, eliminating selves to' remain ignorant of one of the itself as a foreign body, whereas a non­ basic fundamentals of all surgery and in absorbable suture remains as such. so doing have been unable to perform Catgut is prepared in a number of dif­ their best. If the operator can always re­ ferent ways in order to delay its absorp­ member that there is a vast distinction tion. The first 24 feet posterior to the betw:e~n sewing up a piece of cloth and stomach of the sheep are used. The intes­ uniting living, breathing, delicate cells, tine is collected immediately after death *Department'of Surgery, Iowa State College of the animal and started through the com- 24 The Veterinary Student plicated 24 step procedure of prepara­ amount of strength is needed for a pro­ tion. The submucous connective tissue is longed length of time. It is classified as then thoroughly washed, dried and twist­ being fine, medium, or coarse. Its main ed, before its graduation into various sizes. disadvantage is that it can be obtained Sizes range from No. 00000 to No.5, each only in relatively short lengths-an aver­ size being .003 in. larger than the previous age of 12 in. size. No.1 is .018 in. in diameter. Other absorbable sutures used mainly Plain catgut is, as the name indicates, in human surgery include carnofil, nerves, the finished product without the incorpor­ and "living sutures." Carnofil is prepared ation of any of the "hardening" agents. from muscle tissue of the horse, is wiry It is more readily absorbed than "hard­ and flexible, and is used for tension sutur­ ened" catgut; therefore, it can only be ing. Nerves, prepared in a 20 percent ace­ used in tissues that heal rapidly and re­ tic acid solution are used as tension su­ quire no great amount of reinforcement. tures and are absorbed in 12 to 14 days. In most cases it is the material of choice "Living sutures" consist of transplanted in closure of the peritoneum posterior to fascia, aponeurosis or tendons which act the umbilicus, and normal striated muscle. as a reinforcement and are the least irri­ Normal striated muscle tissue is used in tating of all sutures. the standardization of absorption time. Plain catgut varies in absorption time from 5 days for No. 000 to 8 days for Non-absorbable Sutures No.2. The most popular hardened catgut in Non-absorable suture material is sub­ use today is the so-called chromic catgut. divided into those of an inorganic nature It is plain catgut impregnated with and those of an organic nature. chromic trioxide, which produces a "tan­ Inorganic sutures are all metallic and ned" effect on the gut. It is the suture are mostly used in orthopedic surgery, of choice when repairing fascia, periton­ however, they do find some application in eum anterior to the umbilicus, intestine other tissues. and tendons. Chromic catgut is available Silver wire, which is an alloy of silver in sizes corresponding to those of plain and copper, has heretofore been most catgut but is further classified as to ab­ widely used in bone surgery. It has a sorption time, which may be 10 day, 20 considerable amount of tensile strength, day or 40 day. In the selection of chromic but is rather brittle and its knots are none catgut it must be remembered that it will to reliable. Some who use it contend that act as a foreign body until it is absorbed; it exerts an antiseptic action on the tissue therefore, the smallest size which will ful­ in which it is imbedded. In time it de­ fill the requirements should be chosen. generates and disappears. In veterinary In an attempt to avoid contamination surgery it has been used in repair of teat of the tissue catgut has been subjected to wounds in the cow. an iodine solution and marketed as Stainless steel wire has recently be­ "iodized" catgut. Its main advantage lies come quite popular as a skin and tension in the fact that it exerts a germicidal ac­ suture. It is found to be flexible, strong, tion on the tissues. "Iodochromic" catgut smooth, and non-irritating; all of which is another of this type which is treated are conductive to good wound repair, with iodine, potassium iodide, and potas­ particularly where considerable tension sium dichromate. Neither of these mater­ is required of the suture. ials are very widely used. Other metallic sutures include gold, al­ Kangaroo tendon is made from the tail loys and nickeline. Gold is impractical be­ of the wallaby and is exceptionally strong. cause of the cost. The Michel clip and It is thought that the linear arrangement the Murphy button are both alloys and of its fibers makes it more slowly absorbed are used to a limited degree. Michel clips than the spirally arranged fibers of cat­ are quite practical as an external suture gut. It finds its use where a considerable in the closure of wounds. Nickeline is oc- Winter. 1948 25 casionally used in human surgery in su­ silk thread encased in a modified protein turing the abdominal wall. to overcome the capillarity. The most widely used organic suture Silkworm gut is essentially unspun materials of a vegetable origin are linen silk. It is very strong and is used as a and cotton. Linen has been used as a tension suture almost altogether. Its un­ suture material since the days of the desirability lies in its flat, short strands ancient Egyptians. It remains to be quite (about 12 in.) and the difficulty in stand­ popular as a suture because of its strength, ardizing it. but it does present some disadvantages. Horsehair is light, flexible, elastic, and Linen has a capillary action which is un­ relatively non-capillary but has very little desirable in any external suture. This strength. It finds its use mostly in human has been overcome by the development cosmetic surgery. of Pagenstecher's linen which is linen It is to be understood that surgery is thread impregnated with a celluloid-like as much of an art as it is a science, and, preparation. Another of the objections to as it is in all art, great individual differen­ linen as a suture material is that it causes ces are encountered. For that reason no more cellular activity and subsequent hard and fast rule can be laid down for edema and inflammation of the part.
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