Surgical sutures and ligatures pdf

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surgical sutures and ligatures pdf

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Everything You Need to Know About Surgical Sutures

Application November 9, Serial No. The term sutures as used hereinafter in the description of the invention is meant to include both sutures and ligatures. Surgical catgut sutures are composed mainly of collagen which has the property of shrinking or contracting when heated in the presence of water. A catgut suture which has undergone substantial shrinkage or contraction has markedly diminished tensile strength, is irregular in diameter, and consequently has little or no value for use in suturing or ligating.

It is because of the property of collagen, of shrinking or contracting when heated in the presence of water, that heat sterilization of surgical catgut strands to be tubed with an aqueous alcohol tubing fluid, as heretofore and currently practiced, entails a complicated procedure involving the dehydration under stringently controlled conditions before the application of heat of sufficient intensity to kill all microorganisms in vegetative or spore form. In the conventional sterilization procedure, catgut strands of desired lengths are wound into coils and placed in individual glass tubes prior to dehydration and then dehydrated by a carefully controlled heat treatment in which the intensity of the heat is gradually raised until the temperature reaches C.

During the course of the heat treatment hot air is circulated over the mouths of the open glass tubes to facilitate removal of water vapor. An inert anhydrous fluid, such as an aliphatic hydrocarbon having a boiling point above C. The inert anhydrous fluid is drained from the hot tubes under aseptic conditions, an aqueous alcoholic tubing fluid is added to each individual tube, and the tubes are sealed under aseptic conditions.

Although the procedure described above for sterilizing surgical catgut strands is widely practiced and surgical catgut strands sterilized according to the procedure have achieved wide acceptance, the process is attended with numerous disadvantages and shortcomings. Since the surgical catgut strands are sterilized in open tubes, stringent measures and precautions must be taken to prevent recontamination during the steps of the process following the heating of the strand in the presence of an inert anhydrous fluid and until the tubes have been sealed.

Aseptic manipulations are required in aseptic areas during the steps subsequent to sterilization and this requires that all manufacturing operators undergo a procedure comparable to that necessary for personnel participating in surgical operations in an operating theatre.

A procedure of this nature requires that the operators be trained in aseptic techniques and continually alert to the dangers of contamination. Even if all the precautions are taken, acci- 2,, Patented Apr. It is an object of this invention to provide a method for the sterilization of surgical catgut strands in WhlChl'hfi strands are sterilized by the application of heat to a hermetically sealed container containing a catgut strand and an aqueous alcoholic tubing fluid.

It is another object of this invention to provide a process for the sterilization of surgical catgut strands in which the strands are not dehydrated before sterilization. It is still another object of this invention to provide a simple method for the sterilization of surgical catgut strands immersed in an aqueous alcoholic solution which does not require the expensive equipment and the timeconsuming operations necessary when sterilization is performed under aseptic conditions.

It is another and further object of the invention to provide a method of sterilizing surgical catgut strands which provides strands of improved hand, pliability, and tensile strength. The above objects of this invention are accomplished by a sterilization process in which non-sterile surgical catgut strands are hermetically sealed in containers, such as glass tubes or plastic envelopes or tubes, in the presence of an aqueous isopropanol solution and heated.

The concentration of the aqueous isopropanol solutionis required to be within the range of from about to about If the temperature is less than about 90 C. The duration of the heating period may be as long as siX hours without resulting in a substantial decrease in the tensile strength of the strands. It is preferred that the heat treatment be conducted at a temperature of from 91 C. Heating at 94 C. The following examples illustrate various conditions with respect to temperature, time and concentration of aqueous isopropanol satisfactory for use in the sterilization of surgical catgut strands of various sizes according to the invention.

The strands had a diameter of Phar- 2,, I 1 l I macopoeia for size 2 surgical catgut strands. Fifty of the tubes were immersed in a heating bath maintained at a temperature of 90 C. Ten randomly selected tubes from each of the fifty tube groups were opened and tested for sterility by immersion of the strands in sterile culture media and incubation of the media at 34 C.

At the end of the ten-day incubation period there was no bacterial growth in any of the tubes containing the surgical catgut strands. Ten randomly selected strands from each of the fifty tube groups were tested for straight tensile strength and knot tensile strength.

The strands heated at 90 C. The strands heated at 92 C. The strands heated at 94 C. The straight tensile strength and knot tensile strength specified for size 2 surgical catgut sutures by the U. Pharmacopoeia is 13 pounds and 9 pounds respectively. The average straight tensile strength of the strands tested was There was no evidence of microbial contamination in sterility tests of the strands subjected to the heat treatment. Example Fifty five-foot lengths of non-sterile surgical catgut strands having a diameter of Pharmacopoeia within the range oi The U.

Pharmacopoeia specifies that surgical catgut sutures of size 0 have a straight tensile strength of seven pounds and a knot tensile strength of five pounds; There was no evidence of microbial contamination in sterility tests of strands subjected to the heat treatment. The surgical catgut strands sterilized according to the above three examples did not undergo any shrinkage or acquire irregularities of diameter as a result of the sterilization process.

Collagen and particularly surgical catgut strands shrink and thicken when immersed in water at about 60 C. Heating of dehydrated surgical catgut strands at a temperature of C. Dehydrated surgical catgut strands which have been heated at C. The medium in which collagen is immersed while the shrinkage temperature is measured has a very marked effect on shrinkage. In an anhydrous non-polar fluid such as an aliphatic hydrocarbon, shrinkage of surgical actgut strands is negli ible at a temperature not higher than C.

Surgical catgut strands sterilized according to the above examples have a higher shrinkage temperature in water or aqueous alcoholic solution than surgical catgut strands sterilized in a dehydrated form by heating at C. Consequently, surgical catgut strands sterilized by the method of this invention are less susceptible to thermal damage than surgical catgut strands sterilized by the conventional procedure of heating dehydrated strands immersed in an aliphatic hydrocarbon at a temperature of C.

Surgical catgut strands which have been sterilized according to conventional procedures shrink markedly at about C. The higher shrinkage temperature, which is characteristic of surgical catgut strands sterilized according to the method of this invention, indicates damage to the surgical catgut strans is significantly less than the damage resulting from sterilization according to the conventional procedure.

Since certain changes may be made in the conditions of the sterilizing process, it is intended that all matter contained in the above description shall be interpreted as illustrative and not in a limiting sense, but the invention is to be limited only by the scope of the appended claims.

McCulloch, 2nd ed. Q below does not result in shrinkage but the temperature at which such strands shrink in the presence of water is substantially lowered.

What is claimed is: l. USA en. Low temperature vapor phase sterilization and storage of biologically active injectable materials. USB2 en. Gristina et al. Bacterial adherence to biomaterials and tissue. The significance of its role in clinical sepsis. USB1 en. Alexander et al. JPB2 en. DET2 en. CAC en. Packaged antibacterial medical device and method for producing the packaged antibacterial medical device.

Studies in the transplantation of bone: VIII. Treated composite homograft-autografts of cancellous bone: An analysis of inductive mechanisms in bone transplantation.

Banks et al. Hite et al. The effect of pressure on certain micro-organisms encountered in the preservation of fruits and vegetables. Lynch et al. Deep infection in Charnley low-friction arthroplasty. Comparison of plain and gentamicin-loaded cement. Naumann et al. Subcutaneous tissue approximation in relation to wound disruption after cesarean delivery in obese women. SUA1 en. EPA1 en. Sitzmann et al. Septic and technical complications of central venous catheterization.

A prospective study of consecutive patients. CNB en. A kind of dural patch, preparation method and the application in endocranium injury repair. USA1 en. Hansen et al. In vivo model of human pathogen infection and demonstration of efficacy by an antimicrobial pouch for pacing devices.

US2832664A - Sterilization of surgical catgut sutures and ligatures - Google Patents

A surgical suture is a strand Thread used to constrict and or fiber used to hold the seal off the blood vessel, vein edges of various tissues e. Sutures were made of plant materials flax, hemp and cotton or animal material hair, tendons, arteries, muscle strips and nerves, silk, catgut. African cultures used thorns, and others used ant sutures by coaxing insects to bite wound edges with their jaws and subsequently twisting off the insects' heads 3. Earliest reports of surgical suture from ancient Egypt The oldest known suture is found in a mummy A detailed description of a wound suture and the suture materials used by Sushruta. The manufacturing process involved harvesting 10th century sheep intestines developed AD. Joseph Lister introduced the routine sterilization of all suture threads Attempted sterilization - "carbolic catgut".

Abstract · 1-NYLON: (DERMALON): It is either monofilament or multifilament it has minimal · 2-Polymerized caprolactum: use in veterinary surgery.


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Surgeons must select the optimal suture materials for tissue approximation to maximize wound healing and scar aesthetics. Thus, knowledge regarding their characteristics is crucial to minimize ischaemia, excess wound tension, and tissue injury. This article describes the selection of various suture materials available today and their intended design.

The principal object of the invention is the provision of a ligature or suture or absorbable animal tissue of reauisite tensile strength and absorptive properties, which will not have these properties adversely affected by heat sterilization, to devise a novel method of preparing the same. In the application of sutures in the repair of broken bones the material frequently used consists of drawn wire of stainless steel or of silver mixed with copper. Silver wire and steel wire each possesses considerable tensile strength, but the wire must be fastened by twisting the ends because of the difficulty in knotting it. In employing such metallic sutures in holding broken or fractured bones, the wire sutures are threaded through holes drilled in the bones and hence merely hold the broken fragments together without providing any support to the fracture line. Even in breaks producing overlapping ends, such metallic ligatures, being relatively narrow, do not support the fracture line.

Surgical Sutures and Ligatures

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For a number of years I have had it in mind to call attention to the particular method of employing silk ligatures and sutures which has been practiced in the surgical clinic of the Johns Hopkins University since the opening of the Johns Hopkins Hospital in , but have hesitated and also been eager to do so for the same reason, namely, that our school seems to be almost alone in its advocacy of the use of this material. Theodor Kocher, however, has for many years employed silk quite to the exclusion of catgut and our position is greatly strengthened by the support of such eminent authority. Surgeons, old and young, those who have been active and masterful in the marvelous period of development of antiseptic surgery, and the medical student who takes for granted the healing of wounds per primam and the achievements of modern surgery as he does. Halsted WS.

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This article will focus mostly on wound closure, more spe- cifically suturing. It will also deal with other critical aspects of any good surgeon's skill set: knot tying and​.


  • SUTURES AND LIGATURES IN SURGERY. L. CUTAJAR. M.D., F.R.C.S. (Eng.), F.R.C.S, (Edin.) History of suture mltlt;::r~al. The history of sutures is largely a re-. Mafalda A. - 02.05.2021 at 05:16