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Catgut Sutures a Traditional Suture Choice
Although catgut sutures may actually be some of the oldest forms of sutures used in wound closures, there are still many applications that favor the use of this material. Catgut has changed in several ways since the earliest use which may date back as far as the early second century AD. It was an early medical practitioner named Aelius Galenus that is credited with the first use of catgut in suturing wounds and, as a person physician to emperors, the practice quickly became well known.
Catgut sutures were the first of the absorbable sutures. This means that they do not need to be removed but rather, over time, the enzymes produced by the human body degrade the protein in the sutures and gradually dissolve them completely. Without the need for physical removal the catgut can be used in internal tissues and internal organs without either leaving material in the body or requiring additional procedures for removal. The one drawback to catgut sutures is that there is not a define degradation time; rather it is more of a generalized time frame or reference point. Prior to the time that the stitches actually dissolve the tensile or holding strength of the sutures gradually decreases, which can pose potential problems if the wound is not completely healed. Choosing the right diameter catgut is therefore more important than when working with the nonabsorbable suture options.
The first types of catgut sutures were not actually cat gut, nor have they ever been made of the intestinal tracts of felines. They were historically made from the intestines of sheep, most particularly the inner lining of the intestines. This is the same material that formed early strings for musical instruments, although in a much smaller diameter thread. Currently catgut used in sutures is made from cattle or sometimes sheep intestines which are readily available at slaughterhouses. The collagen from the intestines is purified and twisted or braided to form the long threads that are marketed either as pre-cut lengths on needles or on reels for customized length determination.
Modern catgut sutures come in different options. There is a product known as natural catgut, which is treated with glycerol solution and sterilized with ethylene oxide gas. This natural catgut is sold in a moist packaging to prevent the breakdown of the product with dehydration. A dry preparation of catgut treated with chromic salts is also available. The advantage to the chromic catgut is that the chromic salt reduces the rate of protein degradation and extends the life of the suture in the human tissue. Chromic catgut is therefore easier to use since the time between use and the dissolving of the stitches is much more uniform.
Typically catgut sutures are not used to close surface skin wounds so there is no concern with possible contaminants that may increase the rate of the stitches dissolving. In addition some people have a greater inflammatory reaction to catgut sutures over others which will increase the rate of breakdown of the collagen material in the sutures. Research also indicates that using hydrogen peroxide to wash the wound could lead to very rapid disintegration of the suture material, regardless of the type of catgut used.