Self-absorbing threads for sutures in surgery, gynecology, dentistry

Installation of a venous port for long-term access to the subclavian vein very conveniently solves the problems of long-term infusions, which is especially important in modern chemotherapy. In medical practice, for the successful treatment of a number of diseases, the patient requires long-term intravenous administration of drugs: antibiotics, chemotherapy drugs, nutrient solutions, painkillers and monitoring of blood counts. In many public clinics in our country, a peripheral or central venous catheter is still used for this purpose. Not only are these devices outdated, they bring great inconvenience to the patient, reduce the quality of life, but with prolonged use they have a number of complications.

In our article we will talk about infusion port systems and their installation. Frequent punctures of peripheral veins and the administration of anticancer drugs can lead to serious problems over time and limit the options for further treatment. Very often, complications after punctures and installation of peripheral catheters include the entry of an antitumor drug into the surrounding soft tissue, the development of chemical phlebitis, and obliteration (closure) of the lumen of blood vessels.

In the last decade, innovative devices have been introduced into our practice that are installed in the patient’s body for venous access for the purpose of long-term intravenous infusions. These are special implantable port systems that have a huge advantage over classical infusion methods. The port is a special box with a membrane made of titanium alloy, inert to the body. This box is connected to an intravenous catheter, inserted under X-ray control into the subclavian vein. The port can be used not only for infusions of chemotherapy drugs, but also for drawing blood for analysis, administering any other medications and parenteral nutrition.

What is absorbable suture thread?

Absorbable sutures are a surgical material that can decompose on its own. They come in natural and synthetic varieties and do not require a procedure to remove them during the wound healing process. The main characteristics that they can be characterized by are the period of complete resorption and biological strength.

Depending on the type of raw material, there are threads that are completely biodegradable without any residual components. These include catgut, which is made from simple and chrome-plated elements of animal origin. The period of complete decay is almost 3 months.

Absorbable sutures are broken down by the body over time through processes such as hydrolysis and enzymatic degradation. The time required for this depends on the material, as well as the injection site and individual patient characteristics. The rate of absorption of suture material may be increased in patients with ongoing infection, fever, or protein deficiency.

How long does it take for threads to dissolve after surgery?

To understand how many days it takes for the threads to dissolve, you must first ask your surgeon what material was used for suturing. The doctor will not only clarify the information you are interested in, but will also advise how long it will take for the stitches to completely dissolve. Only a specialist can competently assess this process, taking into account the individual characteristics of the patient.

But in general, you need to know how long it takes for the threads to dissolve by looking at the type of threads used during the operation:

• Catgut begins to lose its fixing properties after a month, while the threads finally dissolve only at the end of the 4th month of wound healing;
• Lavsan is often used in cosmetology, since the material begins to deteriorate already on the 10-12th day, but this process can take up to 1.5 months;
• Vicryl has an average degree of resorption: the threads lose their strength after 2-3 months.

In this case, it is worth making allowances for proper care of the postoperative wound according to the scheme recommended by the supervising surgeon. If it is not handled correctly and the rules of personal hygiene are neglected, healing may be delayed and the process of suture resorption may worsen.

Where to buy, price

Surgical suture material can be purchased at any specialty store or on websites that sell medical supplies. You do not need to provide a prescription from a doctor to purchase.

The cost of threads varies depending on the manufacturer’s brand, type of raw material, characteristics and purpose:

Based on the assortment, it is worth noting that threads are an affordable material. The cost is influenced by such parameters as strength index, length and quantity in the set. Despite their different origins and functional purposes, the price of synthetic and natural materials is almost the same.

What material is it made from?

Surgical sutures are used to close most types of wounds. An ideal suture should allow the healing tissue to recover sufficiently so that the incision site remains closed after they are removed or resolved.

All types can be roughly divided into absorbable and non-absorbable materials. Each type has its own classification, where synthetic or natural suture threads are found, as well as monofilament or multifilament materials.

Regardless of the type and classification of suture materials, threads must provide a basic range of functions:

• The ideal seam is the minimum possible seam in width and depth.
• It should provide uniform tensile strength, hold soft tissue securely in the incision area for the required healing time, and then dissolve.
• It should be predictable (in the medical sense in the field of allergies), easy to use.
• The threads may cause minimal body reactions (temperature, itching or irritation).
• The material must form a knot securely.

The choice of the type of suture material largely depends on the clinical picture. For example, mass closure of a midline laparotomy may require the use of a PDS; a vascular anastomosis will likely require prolene, and manual suturing of an intestinal anastomosis may require Vicryl. But to ensure drainage, only a silk suture may be suitable.

Installation of port systems at the Innovative Vascular Center

One of the most important conditions for chemotherapy is the possibility of regular and safe intravenous administration of drugs.

The venous ports implanted at the Innovative Vascular Center are the best replacement for frequent punctures using peripheral or subclavian catheters for patients who require long-term and regular chemotherapy or other frequent long-term intravenous drug administration (intensive care unit patients). Venous ports solve a lot of problems inherent in traditional catheterization methods and provide maximum comfort and quality of life.

Our clinic has mastered and successfully used the technology of installing port systems under X-ray control. The operation takes about 30 minutes and does not require hospitalization. We implant modern venous ports into the subclavian vein under local anesthesia. Puncture of the vessel is carried out under ultrasound control, all further manipulations are performed under X-ray visualization. This approach allows you to avoid complications during this procedure. Local anesthesia is sufficient for complete pain relief for this high-tech operation.

Kinds

Self-absorbable threads for sutures can be divided into several categories depending on the type of cuts:

• absorbable;
• not absorbable;
• wicker;
• synthetic.

When the skin is replaced by a foreign object, the implantation process can cause a soft tissue reaction, which is an absolutely normal mechanism for sensing an object in the human body.

Absorbable absorbable filament material includes:

• monocryl;
• vicryl;
• P.D.S.

When the thread comes into contact with the skin, the hydrolysis process begins:

• Skin closure of a clean surgical wound is most often achieved with an absorbable suture, which provides soft tissue approximation to facilitate the healing process without permanent implantation of foreign tissue.
• Monocryl, developed in the mid-90s, is an absorbable monofilament suture material that has a half-life of 7-14 days, retaining up to 20-30% tensile strength after 2 weeks and is completely absorbed in approximately 100 days.

  
  Monocrylic self-absorbable suture threads

• Vicryl is a widely used alternative and differs from monocryl in that it is a woven (multi-filament) material. Braided sutures are useful because they are less likely to weaken the surgical knot, but theoretically have an increased susceptibility to infection and may cause a more localized tissue reaction.

Non-absorbable sutures also include several types of materials:

• nylon;
• ethylone;
• silk;
• prolene

They are used to bring tissues together for a longer period of time. They can be applied to the skin and removed later, or used inside soft tissues and mucous membranes, where they will remain for a long time. Typically, nonabsorbable suture material is used for vascular, anastomotic, bowel, and tendon repairs.

Classification of raw materials is possible only by purpose and type of properties. Threads are divided according to the criterion of naturalness. Natural fibers include materials made from silk and catgut. They are used less frequently as they cause a stronger tissue reaction. However, silk suture material is still routinely used to close surgical drains.

Synthetic - consists of artificial materials (for example, PDS or nylon). Threads tend to be more predictable than natural seams, especially with regard to loss of tensile strength and absorption.

Suture materials can also be divided according to their structure:

• Monofilament suture is a suture made from single strand fibers (for example, nylon, PDS or prolene). They have a lower risk of infection, but also poor node reliability, despite ease of handling.
• Multifilament thread - consists of several threads twisted together (for example, woven silk or vicryl). They are easier to handle, they retain their shape, providing reliable protection for the nodes, but they can also be carriers of infection. Such materials are not used in dentistry.

Self-absorbable threads are selected according to the criterion for assessing strength. It depends on the factors of skin healing, the age of the patient, and the area of ​​application. For internal seams, special materials are used that have increased strength.

To avoid repeated surgery, the patient may be given a self-absorbable material. In cases where it is not possible or necessary to visit the doctor again, removal of the threads is not required, and in this case it is advisable to introduce more durable raw materials.

Timing of thread resorption after childbirth

Before you get acquainted with the resorption times of threads, you need to know what they are, what they are made of and, in fact, how they dissolve. Absorbable threads are made from natural or synthetic material, and they are able to disintegrate and be removed from the body by the action of enzymes (a kind of digestion occurs) or water (a chemical reaction called hydrolysis). Most often, catgut, maxon, and vicryl are used after childbirth:

• Catgut is a protein suture material that is made from purified connective tissue obtained from the intestinal layers of cattle or sheep. Catgut sutures dissolve completely within a month, the first “detachments” of the threads are observed already on the 7th day. After birth tears and incisions, catgut is most often used to connect both internal and external tissues.
• Vicryl is a modern suture material of synthetic origin, which is most often used during caesarean section. Complete resorption of the threads occurs after 60-90 days.
• Maxon (PDS) is a synthetic thread with a high durability that is used to connect tendons (including after cesarean section). The threads dissolve completely only by the 210th day.

Requirements for surgical suture material

Back in 1966, requirements for suture material were presented by Shchupinsky, who subsequently developed quality standards for raw materials and production of threads:

• Surgical material must withstand the sterilization process by any method.
• Catgut cannot react with tissues; and must have a reversible effect when taking medications.
• Threads should not provoke the development of allergies. If the body gave such a reaction, it means that the doctor diagnosed the patient poorly by choosing the wrong type of material.
• Material of any origin must have hypoallergenic properties.
• The raw materials from which the threads are made must have increased strength, and the threads should not be deformed until the wound has completely healed.
• The knot on synthetic and natural threads should be held firmly, and done easily and quickly.
• The material is resistant to all infections, otherwise it should not be used.
• The process of resorption of all types of threads occurs without consequences for humans.
• During manipulation, the thread must have maneuverability, be elastic, plastic and not have “memory”. The surgeon should be comfortable working with it.
• Any surgical thread should be suitable for various types of operations.
• The suture material should not be electrified.

In the place where the knot is formed, the thread should not lose its properties. This is the most important requirement, since seams and knots can be made in different ways, affecting the structure and integrity of the tissues.

Stitches are also classified into different types based on the use or application of the threads.

Typically, the classification includes the following types:

• common seams;
• cardiovascular;
• valve seams;
• orthopedic;
• dental;
• gynecological sutures;
• veterinary;
• sutures for cosmetic surgery;
• ophthalmic sutures.

Different suture materials can be used for a specific application depending on the requirements.

However, the sizes, lengths, and profiles of needles can be slightly changed for a specific case:

Sharp needles pierce and spread tissue with minimal incision and are used where it is necessary to prevent bleeding. Most often, such models are used in general surgery.

Advantages of port systems

• Implantable port systems provide reliable and safe access for intravenous infusions for many years.
• Port installation is performed on an outpatient basis and is painless for the patient.
• A small incision in the subclavian region heals quickly and does not require the removal of sutures.
• The light weight of the port creates convenience for the patient - after the procedure is completed and the needle is removed, the patient can easily return to an active lifestyle: shower, bath, play sports, swim in the pool, ski and even scuba dive.
• Excellent biocompatibility – minimal risk of port rejection.
• The titanium design of the camera in a plastic housing ensures long-term use and inertness of the port in tissues.
• A dense silicone membrane of large diameter helps to increase the service life of the device - the access begins to work from the first hours after implantation and functions up to 10-14 years.
• The port system does not contain latex, PVC or phthalates, which reduces the risk of infection.

When to use absorbable sutures

Self-absorbing threads for sutures are used in general plastic surgery, facial surgery, as well as in the field of gynecology, when it is necessary to sew soft tissues and mucous membranes. In dentistry, it is common to work with absorbable materials - polydioxanone (PDS), polyglecaprone (monocryl) and polyglactin (vicryl). The thread may have an edge or remain smooth until decomposition.

Absorbable thread is necessary in cases where it is necessary to use a certain type of dental sutures:

• Continuous – This technique involves a series of stitches using a single strand of suture. It is convenient to work with and is durable, since the tension is evenly distributed throughout the continuous thread.
• Interrupted Sutures – This technique uses multiple strands of suture material to close the wound. After the stitch is completed, it is trimmed and tied. This technique results in a securely closed wound. If one of the stitches breaks, the remaining stitches will hold the wound together.
• Deep sutures – This type of suture is placed under layers of tissue below (deep) from the skin. They can be either continuous or intermittent. This suture is often used to close the fascial layers.
• Concealed sutures - the suture assembly is internal (i.e. under or within the area to be closed).

In gynecology, absorbable materials are also used, especially if it is necessary to close large tears for a long time without subsequently damaging the tissue.

One of the most persistent and most visible traces of any abdominal surgery for the patient is the scar at the incision site.

When choosing an incision, the surgeon must consider the underlying pathology causing the operation, the possibility of adhesions or malignancy, and concomitant diseases. The abdominal incisions used for most gynecological procedures can be divided into transverse and vertical incisions.

The primary suture is the line that brings the edges of the wound together during healing by first intention. It may be continuous or intermittent. Other sutures include recessed, purse-string and subcutaneous types.

Hidden seams are applied so that the knot protrudes inward, under the layer being closed. Subcuticular sutures are continuous or broken lines placed in the dermis beneath the epithelial layer.

A secondary suture, called a retention suture, is needed to reinforce the primary suture, eliminate dead space, and prevent fluid from accumulating in the wound while healing by primary intention.

Absorbable sutures are usually used for tissues that heal quickly; as a result, they can be used for small bowel anastomosis, suturing the urinary or biliary tract, or tying small vessels near the skin.

Rules for caring for absorbable sutures

Self-absorbing threads for sutures are used not only on soft tissues and mucous membranes, but also on the surface of the skin.

Until the wound heals, you need to care for the affected area quite carefully:

• It is undesirable for water and aggressive detergents to enter the wound area.
• It is not recommended to wash the suture site in the first 24 hours.
• If there is discomfort or pulsation, you need to treat the wound with ointments and antiseptics.
• During the first week, it is undesirable to allow mechanical actions. For example, if stitches were placed on a finger, it is better to refuse to work with this hand in everyday life and not to use it in writing.
• Sutures placed in the oral cavity must be constantly treated with antiseptic solutions - rinsing on a regular basis.
• Wounds in the mouth heal more slowly, as is the case with mucous membranes on other organs. It will be better if the patient abstains for some time from sunbathing, fluoride-containing medications and toothpaste.

If stitches were placed in the abdominal area, your doctor may prescribe wearing a bandage. This rule should not be neglected.

How long does it take to dissolve?

Depending on the type of seam and leather, the decomposition time of the threads may vary:

It is important to understand that the materials used to provide long-term tissue support may cause different foreign body reactions in the body. And depending on the suture material, the healing process will vary.

If during this period there are no reactions or consequences, then healing is successful:

• Vicryl thread - the body can react within 42 days. If this does not happen, then the recovery process is going well.
• Vicryl tourniquet with barbs - used in general surgery and dissolves in 60 days. During this period, symptoms such as itching may occur. This is considered normal.
• Monocril dissolves in 100 days, and PDS - in 200 days. Often, patients may experience complications for many months due to improper care.

As soon as the thread begins to decompose, its protective functions against infectious diseases weaken. Therefore, it is important to monitor the fusion of the skin even after the threads are reabsorbed. Inflammatory processes may begin shortly before the complete disappearance of foreign materials.

When can you eat after getting stitches in your mouth?

After facial surgery, the patient is prohibited from rinsing his mouth during the day. This is due to the fact that blood clots may remain in the mucosa, preventing infections and drying out of the mucosa.

Eating food and water is not recommended during the first 2 hours. After this time and until the end of the current day, you should not eat hot or cold foods. It is best to limit yourself to soft food at room temperature.

If pain is present, it is better to avoid procedures associated with the process of rinsing and cleaning out food debris. You can take painkillers for relief. In the next few days, it is not advisable to engage in physical labor or lead an active lifestyle until the pain disappears without taking medications.

The doctor may prescribe rinsing the mouth with warm salt water on the second day after surgery. The procedure helps relieve swelling and numbness. However, it must be carried out carefully so as not to clean out blood clots and damage the wound.

How to care for absorbable sutures

Having dealt with the question of how long it takes for the threads to dissolve, it is important to understand how to properly care for the suture after surgery so that healing proceeds safely, the threads are safely torn away, as quickly as possible, and there are no scars left at the site of the intervention.

Please pay attention to the following most important rules for caring for postoperative sutures:

1. The most important point is the sterility of all manipulations performed. Before treating a wound, be sure to wash your hands and thoroughly disinfect all instruments.
2. Depending on the nature of the sutured wound, it must be treated with an antiseptic - brilliant green, Fukortsin, potassium permanganate solution, hydrogen peroxide, medical alcohol. It is better to check with the supervising surgeon what exactly to use. You may have to combine medications and use them together with anti-inflammatory ointments.
3. During water procedures, avoid friction; the wound can only be washed with warm water or a decoction of herbs.
4. If we talk about postpartum sutures, then it is imperative to maintain intimate hygiene - this will prevent complications.

So, in order to find out how long it will take for the sutures to be successfully absorbed after surgery, you must first find out the material from which they are made. It is also worth taking into account the individual characteristics of the body: if you have a tendency to long-healing wounds, then be prepared for the fact that complete resorption of postoperative threads can take up to six months, especially if organic materials were used during suturing of the wound.

Possible complications

The most common complication is an infection that enters the wound during its healing period.

This happens due to a number of reasons:

• drying of the skin;
• moisture ingress;
• neglect of the use of antiseptic solutions;
• wearing bandages that are too tight.

Seeing a doctor in a timely manner will help avoid consequences.

To recognize an infection in time, you need to pay attention to the following prerequisites:

• the skin turns red around the wound;
• itching and an unpleasant feeling of tightness appear;
• numbness or swelling;
• the wound has become warm or hot compared to other parts of the body;
• throbbing and intensifying pain;
• unpleasant odor;
• various secretions;
• increased body temperature;
• swelling of the glands.

In the absence of symptoms, it is important to consider the general condition. If there is weakness or loss of strength, it is worth visiting a doctor, since internal bleeding and infected areas can trigger the development of sepsis.

Self-absorbable suture threads may weaken over time, and this also becomes a direct risk of infection. To protect yourself, you need to replace the seams or purchase a special mesh bandage.

Internal sutures can dissolve over time - in some places the wound will already be closed, but in other places it will still remain a place for bacteria to develop. Periodically you will have to undergo an ultrasound and undergo tests to monitor the overall dynamics of recovery.

Self-absorbable threads have recently been used frequently in the field of medicine and surgery. To make the healing process more comfortable for the patient and not have to undergo a painful procedure again, preference is given to self-absorbable threads.

The sutures create a reliable frame and are selected taking into account the characteristics of the type of operation and the structure of the skin. Today this is the most suitable option for creating suture closures for wounds.