SUTURE MATERIAL — the general
name of the materials used for imposing of surgical seams or bandaging of vessels.
As III. m long since applied fibers of sinews of animals, hair, silk and cotton threads, a metal wire, etc. The significant contribution to scientific development of questions of use of Sh. of m was made by N. I. Pirogov, T. Kokher, Claudius, etc.
Sh. the m shall have a smooth, plain surface and not cause additional damages to fabrics at their underrunning, it is good to slide in fabrics and to be tied strongly in a node, to be elastic, rather extensible not to cause a prelum and a necrosis of fabrics at the accruing hypostasis; to be biologically compatible to living tissues, having at the same time the minimum reactogenicity; bio degradation of threads shall match terms of a wound repair; III. the m shall not have hygroscopic properties, inflate and render allergenic impact on an organism. The strengthened scientific search of Sh. of the m meeting all these requirements was not crowned yet with full success in this connection in modern surgical practice more than 30 types of Sh. of m are used.
The resolving and not resolving threads of a natural and artificial origin were widely adopted. The catgut belongs to the resolving natural threads (see). The simple catgut resolves in fabrics (sometimes to a wound repair). Quite often it causes allergic reactions (see the Allergy) and the expressed inflammatory process around a ligature with formation of alloyed fistula (see the Ligature). Increase in terms of a rassasyvaniye of catgut threads is reached by impregnation them metals (a chrome-plated, serebryony catgut), however it does not deprive of them antigenic properties and ability to cause inflammatory reaction. The resolving threads of an artificial origin from an oktselon (USSR), Dexonum (USA), vikrit (England), etc. are considerably deprived of these shortcomings; they are strong, flexible, elastic and resolve in fabrics in terms, optimum for a wound repair, owing to hydrolysis and macrophagic reaction. Not - the resolving natural threads are threads from silk (see), cotton, a horsehair, flax.
Threads from capron, lavsan, letilan-lavsan, a Dacron, nylon, fluorine of a bosom, etc. belong to synthetic not resorptional-sya threads.
Sutural threads can consist of one fiber (monofilamentnayas thread, monothread) or of several fibers (multifilament thread); fibers in thread can be connected by twisting (twisted fibers) or weaving, knitting (wattled, knitted threads). For the giving of thread of a smooth surface, reduction damaging of irritant action on surrounding fabrics it is covered sometimes with silicone, wax, teflon, etc.
Quite often use Sh. of m from metal. Michel's brackets (plates from stainless steel or nickel alloy 12 — 14 mm long and the 2,7 mm wide, having sharp retractors on the ends) apply to connection of edges of a skin wound; they are imposed special tweezers, the Crimea is squeezed and fix a bracket in the direction, cross to a longitudinal axis of a wound. The metal wire is used for connection of bones. Tantalic paper clips — for imposing of a mechanical seam by means of staplers
Highway of m of any kind causes the same inflammatory reaction from surrounding fabrics (hypostasis, a cytolysis, wrinkling and disintegration of cells) which is most expressed at use of silk and a catgut and least expressed during the use of synthetic monofilament yarns. According to many researchers, existence in fabrics of the ligature which caused inflammatory reaction promotes considerable decrease in local protective properties of fabrics and relative increase in virulence (see) pyogenic microflora and plays a crucial role in development of suppuration of a wound (see. Wound fevers). For reduction of danger of suppuration of a wound the synthetic suture material having antimicrobic activity at the expense of the antiseptic agents entered into its structure is offered (fly - Caen - the mylar, ftorlonovy and acetate rayon fibers containing nitrofu-ranovy drugs, antibiotics, etc.).
Methods of sterilization of Sh. of m are various and depend on its version. Hanks of silk, a catgut, capron can be sterilized by gamma radiation and are soldered in ampoules industrially; store such materials at the room temperature and use as required. Metal III. m will sterilize in the autoclave or boil. Linen or cotton threads, threads from lavsan, caprons, silks can be sterilized in the autoclave, and also by Kokher's method (see Silk) providing power tool cleaning, degreasing, a tanning, sterilization, impregnation by an antiseptic agent. Material is used after control of sterility and store in 96% alcohol with repeated bacterial. control every 10 days.
The catgut will be sterilized also in vapors of iodine (Sitkovsky's method), in spirit solution of Lugol (Gubarev's method) or in water solution of Lugol (Geynats's method — Claudius). At any way of sterilization the catgut is previously subjected to degreasing for what factory hanks place for 24 hours in the ether poured in banks with ground stoppers. For sterilization of a catgut across Sit-kovsky after degreasing thread of a hank is cut on a part 1,25 m long) and carefully wiped with the ball moistened with solution of corrosive sublimate (1: 1000); then threads of zero number lower in 2% solution of potassium of iodide on 30 sec., and threads of other numbers — on the number of minutes corresponding to a thread count. The threads curtailed into ringlets (usually in number of 20 pieces) suspend in banks with ground stoppers at distance 60 — 70 mm from a bottom, on Krom crystal iodine is placed (on 13 — 15 g on 1 l of capacity). Banks mark with the indication of number of a catgut and start date of sterilization. Exposure time for a catgut No. 0, 1 — three days, No. 2, 3, 4 — four days, No. 5, 6 — five days. The catgut is stored in dry sterile glass jars with a ground stopper. For sterilization of a catgut across Gubarev use spirit solution of Lugol (crystal iodine of 10 g, potassium iodide of 10 g, whether 96% of alcohol till 1000) with addition
of formalin 1: 1000. On air fill in with this solution after degreasing ringlets of a zhetgut for 14 days, during to-rykh solution 2 — 3 times replace fresh. Store a catgut in spirit solution ?lyugolya. At sterilization on the Gay natsu — to Claudius the catgut is filled in with water solution of Lugol (crystal iodine of 10 g, potassium iodide of 20 g, a distilled water to 1000 ml). Terms of exposure same, as well as at Gubarev's way; after exposure solution of Lugol is replaced by 96% with alcohol, in Krom the catgut is maintained by 4 — 6 days then it is placed for storage in fresh * by 96% alcohol.
At all methods of sterilization a catgut use only after control bacterial. researches. At storage of a catgut each 10 days replace liquid, in a cut it is stored, and produce repeated bacterial. control.
Bibliography: Pies N. I. Sobra
ny compositions, t. 6, page 187, M., 1961; Re-
a gulyation of an inflammation and regeneration in surgery, under the editorship of V., I. Rusakov, Rostov N / D., 1976; V. I. Pods,
Guo Sr. and shch e in V. K. and With t r at the h to about in Yu. V. Guide to purulent surgery, M.,
1984. V. K. Gostishchev.