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The Case for Gut Sutures
Gut sutures are some of the most traditional types of sutures still in use within hospitals, emergency wards, for first responders and for general use in clinics. As a natural collagen product of either cattle or sheep, these sutures are a good option for soft tissue repair as well as for ophthalmic surgery. Sometimes referred to as catgut sutures, there is absolutely no history of actual catgut being used as the source for the suture material.
Plain gut sutures are considered by many to the ideal suture for general practices and any surgical procedure outside of cardiovascular or neurological procedures. In addition these sutures are used in dental surgery as well as veterinary surgery. The major factor that makes this type of suture so practical for such a range of uses is the absorption rate which prevents the need to have to have the patient return for suture or staple removal. Since the sutures do absorb relatively quickly there is minimal risk of the small tunnels or scars that are common with other types of absorbable sutures and in particular with the nonabsorbable options.
Another major advantage to the use of natural sutures is the minimal amount of foreign body tissue reaction at the wound closure. With minimal acute inflammatory reaction there is less irritation for the patient and less chance of major inflammatory response that can slow down healing time of the wound while, at the same time, increasing the absorption of the suture. With minimal inflammation these sutures have a relatively predicable absorption time as well as an optimal tensile strength for a specifically indicated number of days.
There are several factors that can impact the rage of absorption of any type of absorbable suture. These factures include the specific type of suture used, including the USP size of the suture material. The purity of the collagen used in developing the suture enhances the tensile strength and in vivo performance of the suture under any type of use.
The presence of infection, as indicated above, will increase the absorption rate as increased blood flow and enzymatic activity is triggered within the body. Various tissues, particular those tissues that are located in areas of high blood flow typically have faster absorption rates. The specific response of the individual to the suture is another factor. Different individuals may have slightly faster or slower foreign body responses that may speed up or slow down initial through final absorption.
One option to consider if absorption time variability is a concern is the use of chromic gut sutures. This is simply gut sutures that are treated with chromic salts to decrease absorption rates. Unlike gut sutures that are packaged in water, isopropanol and triethonolmaine, chromic gut sutures can be either dry or wet packaged. For some physicians and surgeons working with one option over the other is more of a personal preference. The smooth surface of gut sutures makes it this material very easy to work with. It provides excellent knot strength and run down and smooth flow through tissue, and is considered by many doctors to the a good suture material for most procedures.