There are several different suture materials used in precise and safe wound closure. Preferably, the choice of the suture material should be based on the biological interaction of the materials employed, the tissue configuration, and the biomechanical properties of the wound. An example of a suture that can be used in such cases is Ethibond suture. It belongs to the class of non absorbable sutures. It is a polyester suture that is composed of fibers of polyethylene terephthalate, which is a synthetic linear polyester resulting when glycol is reacted with a dibasic acid. The polyesters are long chains with a high molecular weight and aromatic rings that recur again and again as a vital part of the compound. Examples of polyester sutures include Surgidac, TiCron made by Syneture Covidien and Ethibond Excel and Ethibond, made by Ethicon.
These polyester sutures were the first man-made braided suture material made known to last for an indefinite period in tissues. Their acceptance in surgery was confined to a small section in the beginning because the suture had a high coefficient of friction. This used to get in the way of the passage through tissue and hampered the construction of a knot. However, with the increase in scientific technology, it was soon learned that these sutures could be coated with a lubricant. Thus, Ethibond sutures gained wide acceptance in surgery. This coating markedly reduced the suture’s coefficient of friction, thereby assisting in knot construction and passage through tissue. All TiCron polyester sutures are coated with silicone, while the surface lubricant for Surgidac is Polybutylene adipate. Due to some surgeons liking to tie sutures with a high coefficient of friction, Surgidac sutures are also obtainable without a surface coating.
Ethibond Excel sutures are uniformly coated with polybutilate, a biologically non reactive and non absorbable compound that attaches itself to the braided polyester fiber strand. This was the first synthetic coating developed specifically as a surgical suture lubricant. The coating eases the passage of the braided strands through tissue and provides excellent pliability, handling qualities, and smooth tie down with each throw of the knot. Both the suture material and the coating are pharmacologically inactive. The sutures draw out negligible tissue reaction and retain their tensile strength in vivo for long periods of time. No significant change is known to occur in vivo. Ethibond Excel sutures are used primarily in cardiovascular surgery, for vessel anastomosis, and placement of prosthetic materials. Anastomosis is the joining together of two organs or vessels that are usually hollow, this is why any preferred brand of polyester suture will work beautifully in valve replacement procedures world wide.
Ethibond Excel is available in two forms, green when dyed and white when not dyed. Ethibond Excel sutures are also available attached to TFE polymer felt pledgets. These are small flat absorbent pads used to medicate, drain, save a wound from harm or serve to put off possible tearing of adjacent friable tissue. They are used on a regular basis in valve replacement procedures. This is to prevent the annulus from tearing when the prosthetic valve is seated and the sutures are tied. They are also used in situations where extreme deformity, distortion, or tissue destruction occurred.