A.J. Dart , C.Grand. Dart , in Comprehensive Biomaterials, 2011
vi.636.1 Introduction
Suture materials play an important role in wound repair by providing support to healing tissues. Closure of pare wounds is only 1 application of suture material. Sutures are used for closure of fascia, hemostasis, intestinal anastomosis and enterotomy, urogenital tract surgery, surgery of the musculoskeletal organization, vascular surgery, ocular surgery, plastic surgery, and neurosurgery, amid other applications. Selection of a suture material should be based on an understanding of the concrete and biological backdrop of the textile, assessment of the wound, the healing rate of unlike tissues, and the patient'due south physical condition. Too frequently, selection has been governed past the personal preference and preparation experience of the surgeon and by economic reasons. Continued technological improvement in suture materials has seen an increase in the variety of sutures bachelor. At the same time, there has been a refinement in suture needles leading to a greater range of options with more tissue-specific applications. The evolution of surgical staples and various tissue adhesives has also provided an alternative to sutures for wound closure. The challenge for surgeons now is to comprehend the enormous choice available and stay abreast of new developments.
The general performance of a suture material is based on its physical properties, handling characteristics, and biological properties. The platonic suture fabric could be utilized for any purpose and would be characterized by expert handling characteristics, have good knot security and tensile force, would be sterile, nonelectrolytic, nonferromagnetic, noncapillary, nonallergenic, and noncarcinogenic, and would not provide a medium for bacterial growth. It should be resistant to shrinkage and captivated with minimal tissue reaction, like shooting fish in a barrel to sterilize without alterations to its backdrop and be economical to use.ane
There is no ideal suture textile. A compromise on the selection of the best suture material for a specific awarding is made past the surgeon and is based on the circumstances. The choice of suture textile will be influenced by the age, weight, and health condition of the patient and the site of the wound. Tissue varies throughout the body in thickness, elasticity, speed of healing, and the tendency to scar. Concurrent diseases such as diabetes, middle illness, dermatitis, and the systemic use of medications such equally steroids may bear upon healing. The presence of infection and private wound characteristics may all influence the choice of suture material. Surgeons should aim to select a fabric that has a loftier forcefulness to bore ratio, is of consistent bore, sterile, pliable, and has optimal tissue acceptance and predictability of functioning.
A.J. Dart , C.1000. Dart , in Comprehensive Biomaterials II, 2017
seven.38.1 Introduction
Suture materials play an important office in wound repair by providing support for healing tissues. Closure of skin wounds is simply one application for suture material. Sutures are used for closure of fascia, hemostasis, intestinal anastomosis and enterotomy, urogenital tract surgery, surgery of the musculoskeletal system, cardiovascular surgery, ocular surgery, plastic surgery, neurosurgery amongst other applications. Choice of a suture material should exist based on an understanding of the physical and biological properties of the material, assessment of the wound, the healing rate of different tissues, and the patient'south physical status. Too often selection has been governed by the personal preference and training experience of the surgeon, and economical reasons. Continued technological improvement in suture material has seen an increment in the diverseness of sutures available. At the same time at that place has been refinement of suture needles leading to a greater range of options with more tissue specific applications. The development of surgical staples, surgical zippers and various tissue adhesives, accept also provided an culling to sutures for wound closure. The claiming for surgeons now is to embrace the enormous choice available and stay beside of new developments.
The general performance of a suture material is based on physical properties, handling characteristics and biological backdrop. The ideal suture material could be utilized for whatever purpose and would be characterized by practiced handling characteristics, have good knot security and tensile strength, would be sterile, non-electrolytic, non-ferromagnetic, non-capillary, non-allergenic, non-carcinogenic and would not provide a medium for bacterial growth. It should be resistant to shrinkage, absorbed with minimal tissue reaction, easy to sterilize without alterations to its properties and economic to utilise (Tan et al., 2003).
There is no ideal suture material. A compromise on the selection of the best suture material for a specific application is made by the surgeon based on the circumstances. The selection of suture material will exist influenced by the historic period, weight, and wellness status of the patient and the site of the wound. Tissue varies throughout the torso in thickness, elasticity, speed of healing and tendency to scar. Concurrent diseases such as diabetes, heart disease, dermatitis and the systemic use of medications such as steroids may effect healing. Presence of infection, private wound characteristics may all influence the option of suture textile. Surgeons should aim to select a material that has high strength to diameter ratio, is of consistent diameter, sterile, pliable, with optimal tissue credence and predictability of functioning.
C.C. Chu , in Biotextiles as Medical Implants, 2013
x.ii Classification of suture materials
Suture materials tin can be classified in different means:
•
by whether they are absorbable and nonabsorbable;
•
by size;
•
by concrete configuration of the threads: monofilament, multifilament, twisted, and braided.
ten.2.1 Absorbable and nonabsorbable sutures
Based on the US Pharmacopeia, absorbable and nonabsorbable sutures are defined equally follows:
•
Absorbable suture materials generally lose their entire or virtually of their tensile force inside 3 months.
•
Those which retain near of their initial strength longer than two–three months are nonabsorbable.
Nonetheless, the availability of some new synthetic long-lasting absorbable sutures pushes the tensile strength retention period beyond 2–3 months. Table 10.A.1 in the Appendix at the end of this affiliate summarizes all commercial absorbable and nonabsorbable suture materials that are bachelor in the United States, Europe and the Pacific, their generic and trade names, their physical configurations, and the names of their manufacturers. Figures 10.i and 10.2 shows the scanning electron microscope images of some of the selected categories of popular sutures.
10.1. Scanning electron images of some commercial absorbable sutures (a) Chromic catgut: polyglycolic acid family; (b) Dexon: poly(glycolide/L-lactide) copolymer or polyglactin 910 family; (c) Vicryl; (d) Vicryl Plus: poly-p-dioxanone family unit; (eastward) PDSII; (f) MonoPlus: poly(glycolide/trimethylene carbonate) copolymer or polyglyconate family unit; (yard) Maxon: poly(glycolide/ε-caprolactone) copolymer or poliglecaprone 25 family; (h) Monocryl: poly(glycolide/ trimethylene carbonate/dioxanone) or Glycomer 631 family; (i) Biosyn: poly(glycolide/trimethylene carbonate/ε-caprolactone) copolymer or Glyconate family; (j) Monosyn: poly(glycolide/trimethylene carbonate/ lactide/east-caprolactone) copolymer or polyglytone 6211 family; and (k) Caprosyn.
x.two. Scanning electron images of some commercial nonabsorbable sutures (a) Silk: polyester family; (b) Mersilene; (c) Novafil: polyamide family; (d) Nurolon; (e) Ethilon; (f) Dermalon; (m) Supramid: polypropylene family; (h) Prolene: polyvinylidene fluoride family unit; (i) Pronova: oly (ether ester) family; (j) Dyloc: poly(tetrafluoroethylene) family; (k) Gore-Tex (fifty) Stainless steel.
A newcomer to the absorbable suture family is TephaFlex® from Tepha which received FDA blessing for marketing in April 2007 (FDA, 2007). TephaFlex® is made using a class of biomaterials known as polydroxyalkanoates, particularly poly-four-hydroxybuytrate (P4HB). P4HB is a natural biomaterial produced by numerous microorganisms through a fermentation process based on Tepha patented recombinant Deoxyribonucleic acid technology. Because of the biological production of P4HB, information technology does non contain rest metal catalysts and is very biocompatible (Martin and Williams, 2003). Due to its thermoplastic grapheme, P4HB can be molded by conventional melt-based processes like cook spinning, extrusion and blowing.
Nonabsorbable sutures are divided into natural fibers (silk, cotton, linen), and man-fabricated fibers. The latter include polypropylene, polyamide, polyester, poly(ether ester), polytetrafluoroethylene (Gore-Tex®), polyvinylidine fluoride (PVDF), and stainless steel. Monofilament Dyloc (from Dynek, Australia) is unusual amongst synthetic nonabsorbable sutures because information technology is made from a nonconventional man-fabricated cobweb: poly(ether ester) (Fig. 10.2). The chief types of material for both absorbable and nonabsorbable sutures are discussed in Chapter eleven.
10.ii.ii Nomenclature by size
Sutures are also classified according to size. Currently, two standards are used to describe size: USP (U.s. Pharmacopeia) and EP (European Pharmacopeia) (Chu et al., 1997). Appendix 2 at the finish of this chapter provides a summary of these. In the USP standard, which is used well-nigh commonly, the size is represented by a series combination of two Standard arabic numbers: a zero and any number other than zero, for example, 2–0 (or 2/0). The higher the first number, the finer is the suture material. Sizes larger than 0 (ane/0) are denoted by ane, 2, 3 etc. This standard likewise varies with the blazon of suture textile. In the EP standard, the code ranges from 0.ane to 10. The corresponding minimum diameter (mm) can exist hands calculated by taking the code number and dividing it by ten. The EP standard does non carve up natural from synthetic absorbable sutures as does USP. Tabular array 10.A.2 in the Appendix at the end of this chapter outlines USP and EP suture size nomenclature
10.two.3 Classification past physical configuration
In terms of the physical configuration of the threads, sutures tin can also be classified into:
•
monofilament;
•
multifilament;
•
twisted; and
•
braided.
Suture materials made of nylon, polyester and stainless steel are available in both multifilament and monofilament forms. Catgut, reconstituted collagen, and cotton are bachelor in twisted multifilament course, while Dexon®, Vicryl®, Monosyn®, Polysorb®, PolySyn FA®, Safil®, silk, polyester-based, polyamidebased suture materials are available in the braided multifilament configuration. PDS®, Maxon®, Monocryl®, Biosyn®, Caprosyn®, MonoPlus®, Monodek, TephaFlex®, Dyloc, polyolefin-based, polyvinylidene fluoride, and Gore-Tex® (polytetrafluoroethylene) suture materials exist in monofilament form only. Stainless steel metallic sutures can be obtained in either monofilament or twisted multifilament configurations. Another unique physical configuration that is available in polyamide sutures and has the trade name Supramid Extra®, has core-sheath pattern: a twisted Nylon vi,6 cadre covered by a Nylon 6 jacket.
Physical configuration of sutures bears a close human relationship to many of import biological effects. The physical structure of nonabsorbable sutures has been shown to be more important in inducing wound infection than the chemical constituents (including the blanket materials). Sutures in multifilament form event in higher rates of infection than the aforementioned material in monofilament grade (Alexander et al., 1967; Blomstedt and Osterberg, 1978; Osterberg and Blomstedt, 1979). For example, Blomstedt and Osterberg (1978) observed that surgical infection rates were higher for multifilament sutures due to high capillary capacity than for noncapillary monofilament sutures. These results were consistent with the Osterberg and Blomstedt report (1979) on the level of inflammatory prison cell reaction nigh implanted and infected suture sites. Both a greater intensity and a longer elapsing of reaction were found around capillary threads than around noncapillary materials. Bucknall and Ellis (1981) also examined the role of the physical structure of sutures on the number of bacteria (Staphylococcus aureus) taken upwardly by four types of sutures (silk, polyglycolic acid (PGA), multifilament and monofilament nylon) and found that braided sutures (silk and nylon) took up 3 × more than Due south. aureus than monofilament (nylon) sutures. They concluded that it was the physical structure of a suture that controlled the amount of leaner that the material attracted. A contempo report of the capillary phenomena of sutures by Geiger et al. (2005) likewise suggests that none of the iv/0 monofilament sutures (PDSII, Maxon, Monocryl, Monosy, Biosyn, Prolene) showed bacteria (Escherichia coli) transport, while the majority of the multifilament sutures (except Perma-hand silk and Ethibond polyester sutures) were able to transport E. coli. Bacterial transport was more evident, if a mobile leaner like Proteus mirabilis was tested.
It has been postulated that due to the topology of the multifilament suture, it is difficult for inflammatory cells to attain the leaner hiding deep in the interstices of the structure. Hence, phagocytic action is retarded. It has also been suggested that multifilament sutures induce stronger tissue reactions, and hence weaken the tissue'due south defense against leaner. Thus, the caste of infection by a suture is parallel to the degree of inflammatory reaction caused past the suture. The relatively college resistance to infection of chromic and iodized catgut sutures, compared to evidently catgut sutures, further demonstrates this human relationship between infection and inflammation.
RICHARD H. LASH , ... ROBERT M. GENTA , in Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas (2d Edition), 2009
Foreign Bodies
Suture cloth is a common cause of granulomas in the tummy in patients who accept undergone a fractional gastrectomy. In patients with gastric ulcer, food particles may become engulfed within the ulcer crater, where they may cause a foreign-trunk reaction (and so-called cereal granulomas). When granulomas are constitute in biopsy specimens obtained from active ulcers, their origin is readily credible. Even so, diagnostic difficulties may arise when granulomas are found in specimens from healed ulcers, and the pathologist lacks the appropriate clinical information. Thus, exam under polarized light should always be performed in cases of granulomatous gastritis.
Rubber Cess including Electric current and Emerging Problems in Toxicologic Pathology
Mary Elizabeth Pecquet Goad , Dale Fifty. Goad , in Haschek and Rousseaux's Handbook of Toxicologic Pathology (Third Edition), 2013
3.ane Soft Tissue Defects and Injury Repair
Suture cloth and associated grids, sponges, and meshwork implants placed at the fourth dimension of surgery are the nigh common and widely used biomaterials and implanted devices. Suture materials and other materials used in soft tissue repair autumn into ii basic categories: absorbable and non-absorbable. Absorbable sutures are designed to degrade over time; they are intended to stay intact for the length of fourth dimension required for healing. Examples of absorbable sutures are chromic gut, polyglycolic acrid, polylactic acrid, polydioxanone, and caprolactone. Not-absorbable materials include silk, metals (eastward.g., stainless steel sutures and staples), synthetic plastics (e.g., nylon sutures), and meshes (eastward.1000., polypropylene [Prolene™, Marlex®] and polyester [Mersilene®], and polytetrafluoroethylene [PTFE, Teflon®, or Gore-Tex®]).
Materials for repair of incisions, lacerations, defects, or hernias are assessed for their ability to withstand tearing, their breaking pressures and tensile strength, the ability to elicit a long-lasting fibrotic reaction, and biocompatibility. The fibrotic reaction in soft tissue repair helps to retain the suture or implant at the site and strengthens the repair. These materials must retain both forcefulness and flexibility to ensure repair and to reduce pain, which is a major drawback with stainless steel staples and sutures.
The goal of absorbable materials is maintenance of the function of the fabric for a temporary period earlier the material is degraded and eliminated without concrete intervention. Biodegradation occurs via controlled enzymatic or biologic processes that include the host's reaction to the materials. Hurting or discomfort may be associated with those materials that elicit an inflammatory response.
Resorbable polymers have been used for decades as suture materials. More recently, resorbable polymers accept been used to develop temporary internal fixation devices, such as pins, screws, suture fabric anchors, portions of implanted joints, and os conductive surfaces. Polymers are as well the drug delivery component of composite devices. Biodegradation of carrier polymers within drug-eluting stents controls the rate of agile drug release.
These devices are designed to dissipate over a catamenia of time, which is governed by the choice of fabric and the location. Selection of the polymer in these devices is based on length of time to resorption, and intensity of the body's reaction to the material. Some absorbable implants are designed to remain for months or years, whereas others are intended to final for a shorter duration. Implants that evoke continuous and intense astute inflammation may exist resorbed or degraded more than rapidly than those that evoke milder and more chronic responses.
Resorbable chromic gut suture ("cat gut") is the standard fabric used to compare local tissue reactions for implant biocompatibility (American Society for Testing and Materials International Standard [ASTM]). That is, local tissue reaction and repair post-obit implantation of chromic gut is the baseline for the feature intense foreign body response to implant biomaterials. Typically, chromic gut elicits an intense acute pyogranulomatous reaction (Figure 26.1). Depending on the site of implantation, chromic gut can be resorbed, phagocytized, or dissipated in 7–28 days and can induce proportionately large pyogranulomas, which resolve as the gut is resorbed.
FIGURE 26.1. Chromic gut implanted in rabbit lumbar muscle fourteen days after surgery in a biocompatibility study. (A) The chromic gut has non been resorbed. The dark eosinophilic chromic gut (CG) is surrounded past focal mild to moderate chronic inflammatory reaction (arrowheads) characterized by infiltrates of macrophages, foci of lymphocytes, occasional heterophils, and fibrous connective tissue. The muscle has some degenerating fibers (pointer); the inflammatory response is localized to the site of gut implantation. (20× H&E.) (B) Chromic gut (CG; dark homogeneous eosinophilic area on left) is intact and surrounded past chronic inflammation with numerous macrophages and a few multinucleated behemothic cells (arrowhead). Lymphocytes and occasional heterophils are nowadays equally are fibrous connective tissue components. (60×, H&Eastward.)
Mary E.P. Catalyst , Dale L. Catalyst , in Handbook of Toxicologic Pathology (Second Edition), 2002
A. SOFT TISSUE DEFECTS AND INJURY REPAIR
Suture material and associated grids, sponges, and meshwork implants placed at the time of most surgeries are the about common and widely used biomaterials and implanted devices. Suture materials and other materials used in soft tissue repair fall into two bones categories: absorbable and nonabsorbable. Nonabsorbable materials include mainly metal and synthetic plastics such as stainless steel suture and staples, nylon sutures and meshes, and polytetrafluoroethylene (PTFE, Teflon or Gore Tex). These materials are used to create nonabsorbable implants, including polypropylene (Prolene, Marlex) and polyester (Mersilene).
Incision, defect, or hernia repair materials are assessed for their ability to withstand tearing, breaking pressures, tensions, their tensile strength and their ability to elicit a long-lasting fibrotic reaction, and their biocompatibility. For soft tissue repair, the surgeon often relies on the evolution of a fibrotic reaction to the implant. This fibrosis will non just keep the implant in the desired location, merely will also add together to the strength of the material. These materials must too be flexible and not cause pain. This is a major drawback of metal in soft tissue repair, and stainless-steel staples and sutures induce pain locally because they are hard and inflexible compared to the surrounding tissue. A more recent problem with metal implants is detection by metal-detecting devices used to go on out weapons.
Absorbable materials are absorbable or biodegradable because of their composition and because of the host or body reaction to those materials. With these materials, pain can exist elicited due to the inflammatory reaction produced. The unique backdrop of the different absorbable materials are used to the surgeon's reward. Bioabsorbable or biodegradable devices have expanded to include internal fixation devices such as pins, screws, suture fabric anchors, and bone conductive surfaces. These devices are designed to dissipate over a length of time governed past the option of cloth.
Selection is based on length of fourth dimension to resorption and intensity of the torso'due south reaction to the material. Some absorbable implants are designed to last months or years. Control of the biomaterial resorption rate takes advantage of the torso'south reaction to the material. Implants that evoke continuous and intense astute inflammation may be resorbed or degraded more rapidly than those that evoke milder and more chronic responses.
Resorbable chromic gut is the standard cloth used to compare local tissue reactions for implant biocompatibility of virtually biomaterials for whatever use. That is, local tissue reaction and repair following implantation of chromic gut is the baseline for the characteristic intense response to implant biomaterial. Typically, chromic gut elicits an intense astute reaction most typical of a pyogranuloma. Depending on the site of implantation, chromic gut can be resorbed, phagocytized, or dissipated in 7 to 10 days and can induce proportionately big pyogranulomas, which resolve every bit the gut is resorbed.
Benjamin C. Marcus , in Local Flaps in Facial Reconstruction (Second Edition), 2007
Suture characteristics
The ideal suture material should be easy to handle, have loftier tensile strength, and have no tissue reaction (Table 4-ii). A variety of suture materials are bachelor for soft-tissue surgery. Pick of a particular type is dependent on the physical characteristics of the material. A set of common terms and definitions are presented in Table 4-3. Given the multitude of requirements of cutaneous and reconstructive procedures, at that place is no single suture suited for all wound closures. In office, the outcome of wound repair is dependent on the type of suture material and needle architecture selected. Inappropriate needle or suture material can create tissue damage at the wound interface and impact the ultimate artful results. One important characteristic of suture cloth is its coefficient of friction. Different types of suture filaments have varying levels of friction (Fig. 4-13). A higher level of friction results in increased local tissue impairment. In general, monofilament sutures take the lowest coefficient of friction. Examples of monofilament sutures include Nylon and Polypropylene. Braided sutures with higher coefficients of friction can be fabricated more "slippery" with coating agents. Common coating agents include silicone, organic waxes, and polymers of suture material such as Polygalactin 370 and Polycaprolate. Another important suture feature is elasticity. During wound healing there is local tissue edema and the suture material used for repair of the wound should have sufficient elasticity to accommodate the change in tissue volume without compromising wound approximation. Poliglecaprone 25 (Monocryl, Ethicon) and Polybutester (Novafil, Davis and Geck) are ii materials that take excellent elasticity profiles.
All suture material elicits an inflammatory response in the tissue where the suture is placed. The response may exist related to the physical nature of the suture cloth (blanket materials), or a patient's allowed reaction to the fabric. Chromic and plain gut sutures are associated with significant tissue reactions.11 These collagen-based sutures are absorbed past neutrophil-mediated proteolysis. A nonspecific inflammatory response accompanies the arrival of neutrophils resulting in local tissue reaction. In contrast, a variety of synthetic absorbable suture fibers are absorbed by simple hydrolysis, which is associated with limited inflammation. Nonabsorbable fibers do not undergo local degradation and elicit the least inflammatory response.
Other of import suture characteristics include pliability, tensile strength, and absorption profile. The pliability of suture textile affects the ease of employ. A more pliable suture will facilitate creation of a knot. In contrast, a potent suture material volition be more difficult to work with. Rigid suture material is more resistant to knotting and has an increased material retentivity. In full general, braided sutures are the well-nigh pliable. Monofilament sutures have the greatest memory and require precise handling when creating a knot.
The tensile strength of suture material is important for maintaining wound approximation. For a given wound closure a smaller guess suture may be used if it possesses sufficient tensile strength. Conversely, mechanically weaker suture mate-rial must have a larger caliber to close similar wounds. In repairs where in that location is pregnant wound closure tension, a smaller gauge suture with high tensile strength can cut through the wound edges as information technology transmits wound closure tension to the local tissue. For all-time results, the suture used should be no stronger than the tissue it is approximating. The strength of private tissue types is detailed in Table 4-4.
The Us Pharmacopeia (USP) classification system was established in 1937 for standardization and comparison of suture materials. The graded system has a directly correlation to metric measures. Suture size describes the bore of the suture strand and is graded by a series of zeros. Somewhat paradoxically, the more zeros a suture has, the smaller information technology is (e.g., 5-0 is smaller than 4-0). Suture materials are also divided into three classes: collagen, synthetic absorbable, and nonabsorbable. USP specifications for each form are detailed in Tables 4-5, iv-6, and 4-7. Review of these specifications reveals several inconsistencies of the USP organisation. The true metric size and USP size have some variation betwixt the iii classes. Additionally, metric size does not perfectly correlate with suture knot tensile strength. Lastly, while the USP specifications fix the minimum tensile strength for a given suture size they do non prepare an upper limit. Therefore, sutures in the same USP course may have very different tensile strengths.
Dennis C. Hammond Md , in Atlas of Aesthetic Breast Surgery, 2009
Suture material
The optimal suture material is a permanent monofilament, which slides much more easily through the dermis than a braided suture which tends to catch and become resistant to movement as information technology is passed through a dermal length of more than than 3 or iv cm. When the suture material passes hands through the dermis, it facilitates an even cinching down of the periareolar opening without whatever asymmetrically positioned crimping or bunching of the pare edges. The use of a permanent suture as well provides long-term back up to the periareolar closure. When absorbable materials are used, reabsorption of the suture can occur before scar stabilization of the tissues has occurred. By using a permanent suture, the chances for postoperative areolar spreading are minimized. Although materials such as nylon and prolene can be used for smaller diameter openings, the ideal suture for this purpose is Gore-Tex (Gore Tex Corporation, Flagstaff, Arizona). This material, which comes from the disciplines of vascular and cardiovascular surgery, where information technology has been used in conjunction with vascular grafts for years, is a very strong, shine and permanent textile that slides through tissues with ease. The optimal suture size to use is CV-3, which has a soft and manageable pliability and great strength, all with the size of about a 2–0 prolene suture. By cutting off the curved needles on either end and threading the suture onto a directly needle, long passes with the needle through the dermal layer of the outer periareolar incision can be made, which speeds suture placement. Alternatively, a slightly larger but stronger CV-2 suture may be used. This particular suture comes already swedged onto a straight needle, which obviates the need to thread the suture separately (Figure five.18). In one case the suture is placed, information technology then becomes very easy to sure-fire the periareolar defect downwards to the desired dimension as the Gore-Tex easily slides through the soft tissues without catching or bunching. Using this suture material provides for a precise and controlled direction of the periareolar opening over and above that which is possible with any other suture material.
Jon B. Suzuki , Randolph R. Resnik , in Misch's Fugitive Complications in Oral Implantology, 2018
Low Tissue Reactivity
Tissue reaction from the suture material has been shown to be exhibited through an inflammatory response, which volition ordinarily develop during the first 2 to 7 days subsequently suturing the tissue. The suture material selected should have an inherent low tissue reactivity.42a Low tissue reactivity means that the suture material should exhibit a minimal inflammatory response, which volition not delay wound healing nor increase infection charge per unit. Tissue reaction is reflected through an inflammatory response, which develops during the first 2 to 7 days afterward suturing the tissue.ane-3 Several studies published over the past iv decades have reported that constructed materials showroom a superior behavior to oral tissues in terms of tissue inflammatory reactions compared to nonsynthetic suture material.
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