Any average person, one way or another throughout his life, at least once faces serious wounds or operations. In both cases, the doctors sew up the injuries to speed up the healing process. What is the difference between a surgical thread and the usual one?
When seams are needed
Deep cuts and wounds, abdominal operations, other injuries - most people in one way or another are faced with the fact that they have to stitch their tissues for better and faster healing. For a long time, this problem, along with effective analgesia, 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, with every gladiatorial school there was a doctor who treated the wounds of soldiers after unsuccessful performances. In the Middle Ages, medicine as a whole fell into disgrace, and all knowledge of the past was forgotten to be restored in the Renaissance and the New Age.
The need for healing wounds has never disappeared, because throughout the course of human history wars have been constantly waged, and in peacetime a sterile surgical thread saved many lives. How did she come about?
History
Science has a sufficiently 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 in human anatomy.
The first documented use of suture material took place 2000 BC. The use of threads and needles in wound healing has been described in a Chinese treatise on medicine. In those days, the skin was sutured with horsehair, animal tendons, cotton fibers , trees and other plants. In 175 BC, Galen first mentioned catgut, which was made from the connective tissue of livestock. Until the 20th century, it remained almost the only suture material. However, in 1924, material was invented, which was later called nylon. It is considered the first synthetic thread suitable for suturing wounds. A little later, lavsan and kapron appeared, which almost immediately began to be used in surgery. Polypropylene was invented in the middle of the century, and artificial absorbable fibers in the 70s.
At the same time as the surgical thread changed, metamorphoses and needles underwent. If earlier they were no different from ordinary ones, were reusable and injured the tissues themselves, then later they acquired a modern curved shape, became thinner and smoother. Modern disposable needles are atraumatic, on their surface micro-roughness is filled with silicone.
Modern suture material
In surgery of the 21st century, threads of various origins and properties are used. They can be both natural and synthetic. There are also those that, after some time after the operation, resolve independently when the need for them disappears. With their help, internal tissues are often sutured, while for external ones, ordinary ones that can be removed later can be used. The final decision on this is made by the doctor, depending on various factors, the nature of the wound and the condition of the patient. He also estimates the size of surgical sutures, choosing the appropriate thickness to support the tissue, but not to injure them once again.
Requirements
There are a number of properties that a modern surgical thread should possess. These suture requirements were formulated in 1965. However, they are relevant today:
- simple sterilization;
- hypoallergenicity;
- low cost;
- inertia;
- strength;
- infection resistance;
- absorbability;
- universality for any fabrics;
- plasticity, comfort in the hand, lack of memory thread;
- lack of electronic activity;
- node reliability.
Modern natural and synthetic surgical sutures somehow meet most of these requirements. Most often, with the right treatment, even the most serious 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 performed, and often patients recover in a fairly short time.
Thickness
Of course, over several thousand years, the surgical thread has undergone major changes and cannot be compared with what the doctors were forced to use at that time.
Today, doctors have a wide arsenal of a wide variety of suture material, suitable for a variety of body tissues. The most understandable characteristic for the layman is the thickness of the surgical sutures. The strength and invasiveness of the suture and, accordingly, the wound healing time depend 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 thread;
- multi-fiber, which, in turn, can be twisted or woven.
Each of these species reveals its advantages, disadvantages and features. So, monofilament has such advantages:
- Smoothness. In structure, this type is less traumatic, which avoids more bleeding.
- Easy to manipulate. Monofilament is often used for intradermal sutures, since it does not grow to tissues and is 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 form between them, which are filled with the contents of the wound, increasing the risk of infection. With monofilament, there is no such danger.
- Inertia. A single-fiber thread irritates the skin less; when used, the chance of wound inflammation is lower.
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 nodes - they irritate tissues and slow down healing. Since monofilament has a smoother surface, it does not hold complex structures very well. When using this type of material, more knots have to be used to keep the seam better.
To improve the properties of filaments, they are coated with different compositions to reduce the risk of infection, increase smoothness and biocompatibility. In addition, work is ongoing on new fibers and materials, so that surgery does not stand still.
Catguts and cellulosic materials
As already mentioned, the surgical thread, whose name comes from the phrase cattle gut , was one of the first. Today, its production technology is much more advanced than before, there is a suture material with chrome spraying, which increases strength and resorption time.
This is still a very popular type of thread, despite the fact that its use in some cases is equivalent to organ transplantation and may cause an appropriate immune response. Nevertheless, the catgut is perfect if the seam is needed for a short time, because after 10 days it can dissolve in half, and after 2 months it will completely collapse, having fulfilled its purpose.
From the fibers of cellulose make a multifilament called okcelon and katselon. They also have a relatively short resorption period, which makes them indispensable in urology, plastic and pediatric surgery. Moreover, they have an important plus - they are not rejected by the body as foreign tissues.
The rest is absorbable
Other surgical sutures have a longer elimination period, which is useful in general, thoracic and oncological surgery. Polydiaxanone resolves for the longest time - it takes 6-7 months to completely disappear.
The advantage of artificial fibers is that they contribute to faster and cleaner wound healing, reduce the risk of any complications and inflammations. That is why catgut is gradually abandoned, finding safer analogues.
Silk and nylon
These two types are surgical sutures that are absorbable conditionally. In practice, this means that it takes several years to remove them from the body. Silk has long been considered the gold standard, possessing versatility in use. However, due to the fact that its fibers are of natural origin, the seams with its use are often inflamed and require more attention to themselves. But at the same time, it is very elastic, durable and soft, which earned the love of surgeons.
Kapron thread also often causes an inflammatory reaction. Nevertheless, it is often used for stitching tendons and in ophthalmology.
Non-absorbable
Surgical sutures, which then have to be removed manually, are also quite diverse. Some of them have excellent manipulative properties, but are reactogenic. Others are inert and safe, but inconvenient in operation and have little strength. Nevertheless, almost all of them are widely used both in general and in specialized surgery.
The following groups are distinguished:
- Polyolefins - prolene, polypropylene. Despite the fact that such seams are almost never festering, the convenience in operation leaves much to be desired, and you also have to tie a lot of knots.
- Polyesters - nylon and lavsan. Mainly used to support stretched tissue and in endoscopic operations.
- Fluoropolymers. The most perfect group - they have good handling properties and sufficient strength. Do not require a large number of nodes.
Steel and titanium
It may even seem strange, but metal is still used in surgery in the form of both a thread wire and a bracket for a special apparatus. A serious drawback is trauma to surrounding tissues. Nevertheless, in some cases, in orthopedics and bone surgery, metal cannot be replaced with anything.
So, there are a great many varieties of suture material. They are used for different purposes, and it is very important which surgical thread will be chosen in the end. The name, of course, does not play any role here, but the doctor always takes into account many factors, deciding what will be better for the patient.