Any average person one way or another during his life at least once faced with serious wounds or operations. In both cases, the damage is sewn up by doctors to speed up the healing process. What is the difference between a surgical thread and a regular thread?
When stitches are needed
Deep cuts and wounds, abdominal surgery, other injuries - most people in one way or another are faced with the fact that their tissues have to be sewn together for better and faster healing. For a long time, this problem, along with effective anesthesia, was the main obstacle to the further development of surgery.
Throughout history there have been several periods of rise and fall of this discipline. So, in ancient Rome, surgery experienced an unprecedented development, each gladiatorial school had a doctor who treated the wounds of fighters after unsuccessful performances. In the Middle Ages, medicine as a whole fell into disfavor, and all the knowledge of the past was forgotten, only to be restored in the Renaissance and Modern Times.
The need for wound healing has never disappeared, because throughoutIn human history, wars were constantly fought, and even in peacetime, sterile surgical thread saved many lives. How did she come about?
History
Science has a fairly large number of evidence that the first operations, including quite complex ones, were carried out long before the advent of special tools and deep knowledge of human anatomy.
The first documented use of suture material took place 2000 BC. The use of threads and needles in wound healing was described in a Chinese treatise on medicine. In those days, the skin was sewn together with horsehair, animal tendons, cotton fibers, trees and other plants. In 175 BC, Galen first mentions catgut, which was made from the connective tissue of livestock. Until the 20th century, it remained practically the only suture material. However, in 1924, a material was invented that was later called nylon. It is considered the first synthetic thread suitable for suturing wounds. A little later, lavsan and capron appeared, which almost immediately began to be used in surgery. In the middle of the century, polypropylene was invented, and in the 70s, artificial absorbable fibers.
At the same time as the surgical thread was changing, the needles also underwent metamorphoses. If earlier they did not differ in any way from ordinary ones, were reusable and injured tissues by themselves, then later they acquired a modern curved shape, became thinner and smoother. Modern disposable needlesatraumatic, on their surface micro-roughness is filled with silicone.
Modern suture material
In 21st century surgery, threads of various origins and properties are used. They can be either natural or synthetic. There are also those that, some time after the operation, dissolve on their own when the need for them disappears. With their help, internal tissues are often sewn together, while ordinary tissues can be used for external ones, which need to be removed later. The final decision about this is made by the doctor, depending on various factors, the nature of the wound and the condition of the patient. He also evaluates the size of the surgical threads, choosing the appropriate thickness to support the tissues, but not injure them once again.
Requirements
There are a number of properties that a modern surgical thread should have. These requirements for suture material were formulated in 1965. However, they are still relevant today:
- simple sterilization;
- hypoallergenic;
- low cost;
- inertia;
- strength;
- resistance to infection;
- absorbable;
- versatility for all fabrics;
- plasticity, comfortable in hand, no thread memory;
- lack of electronic activity;
- node reliability.
Modern natural and synthetic surgical sutures meet most of these requirements in one way or another. Most often, with proper processing, even the mostserious wounds can be healed. And thanks to this, surgery could successfully develop to the modern level, when both micro-level operations and complex manipulations with such important organs as the heart and brain are carried out, and often patients recover in a fairly short time.
Thickness
Of course, for several thousand years, the surgical thread has undergone major changes and cannot be compared with what doctors were forced to use at that time.
Today, doctors have a wide arsenal of various suture materials suitable for a wide variety of body tissues. The most understandable characteristic for the layman is the thickness of the surgical threads. The strength and traumatism of the seam and, accordingly, the time of wound healing depends on it.
There are about two dozen threads that differ only in thickness. Moreover, the values vary from 0.01 to 0.9 millimeters. Thus, the very first in a series of these threads is about 8 times thinner than a human hair!
Varieties
Initially, two types of suture material are distinguished:
- monofilament surgical suture;
- multifilament, which in turn can be twisted or braided.
Each of these types has its own advantages, disadvantages and features. So, monofilament has the following advantages:
- Smoothness. In terms of structure, this type is less traumatic, which avoidsmore bleeding.
- Easy to manipulate. Monofilament is often used for intradermal sutures because it does not adhere to tissues and can be easily removed if necessary.
- No wick effect. This phenomenon lies in the fact that when the fibers do not fit tightly to each other, microvoids are formed between them, which are filled with the contents of the wound, increasing the risk of infection. With monofilament, there is no such danger.
- Inertia. Single-fiber thread is less irritating to the skin and less likely to cause wound inflammation.
At the same time, monofilament suture material has one significant drawback. Relatively low strength. The requirements for modern threads are such that there should be a minimum number of knots - they irritate tissues and slow down healing. Since monofilament has a smoother surface, it does not hold complex designs very well. When using this type of material, more knots must be used in order for the seam to hold better.
To improve the properties of the threads, they are coated with various compounds to reduce the risk of infection, increase smoothness and biocompatibility. In addition, new fibers and materials are being developed all the time, so the surgery never stands still.
Catguts and cellulose materials
As already mentioned, the surgical thread, whose name comes from the phrase cattle gut, was one of the first. Today, the technology of its production is much more advanced than before, there is a chromium-plated suture material,increasing strength and resorption time.
This is still a very popular type of thread, despite the fact that its use in some cases is tantamount to organ transplantation and can trigger an appropriate immune response. Nevertheless, catgut is great if the stitch is needed for a short time, because after 10 days it can dissolve by half, and after 2 months it completely collapses, having fulfilled its purpose.
Polyfilaments called occelon and kacelon are made from cellulose fibers. They also have a relatively short resorption time, which makes them indispensable in urology, plastic and pediatric surgery. At the same time, they have an important advantage - they are not rejected by the body as foreign tissues.
Other absorbable
Other sutures have a longer lead time, which is useful in general, thoracic and oncosurgery. Polydiaxanone takes the longest to dissolve - it takes 6-7 months for its complete disappearance.
The advantage of artificial fibers is that they promote faster and cleaner wound healing, reduce the risk of any complications and inflammation. That is why catgut is gradually being abandoned, finding safer analogues.
Silk and nylon
These two types are surgical sutures, conditionally absorbable. In practice, this means that it takes several years for them to be removed from the body. Silk has long been considered the gold standard,versatility in application. However, due to the fact that its fibers are of natural origin, the seams with its use often become inflamed and require more attention. But at the same time, it is very elastic, durable and soft, which earned it the love of surgeons.
Nylon thread also often causes an inflammatory reaction. However, it is often used for tendon sutures and in ophthalmology.
Non-absorbable
Surgical threads, which then have to be removed manually, also differ in sufficient variety. Some of them have excellent manipulation properties, but are reactogenic. Others are inert and safe, but inconvenient to work with and have little strength. Nevertheless, almost all of them are widely used in both general and specialized surgery.
The following groups are distinguished:
- Polyolefins - prolene, polypropylene. Despite the fact that such stitches almost never fester, the ease of use leaves much to be desired, and you also have to tie a lot of knots.
- Polyesters - nylon and lavsan. Mainly used to support stretched tissues and in endoscopic operations.
- Fluoropolymers. The most perfect group - have good handling properties and sufficient strength. Do not require a large number of nodes.
Steel and titanium
It may even seem strange, but the metal is still used in surgery in the form of both a thread-wire and a staple for a special apparatus. A serious drawback is injury to surrounding tissues. However, in some cases in orthopedics and bone surgery, nothing can replace metal.
So, there are a great many varieties of suture material. They are used for different purposes, and it is very important which surgical thread is chosen in the end. The name, of course, does not play any role here, but the doctor always takes many factors into account when deciding what is best for the patient.
