Catgut suture
Encyclopedia
Enzyme
Enzymes are proteins that catalyze chemical reactions. In enzymatic reactions, the molecules at the beginning of the process, called substrates, are converted into different molecules, called products. Almost all chemical reactions in a biological cell need enzymes in order to occur at rates...
s. Absorption is complete by 90 days, and full tensile strength
Tensile strength
Ultimate tensile strength , often shortened to tensile strength or ultimate strength, is the maximum stress that a material can withstand while being stretched or pulled before necking, which is when the specimen's cross-section starts to significantly contract...
remains for at least 7 days. This eventual disintegration makes it good for use in rapidly-healing tissues and in internal structures that cannot be re-accessed for suture removal.
Catgut suture has high knot-pull tensile strength and good knot security due to special excellent handling features. It is used for all surgical procedures including general closure, ophthalmic, orthopedics, obstetrics/gynecology and gastrointestinal surgery. It is absorbed faster in patients with cancer, anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
, and malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
. It also absorbed faster when used in the mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
and in the vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
, due to the presence of microorganism
Microorganism
A microorganism or microbe is a microscopic organism that comprises either a single cell , cell clusters, or no cell at all...
s.
Catgut has largely been replaced by synthetic absorbable polymers such as Vicryl
Vicryl
Vicryl is an absorbable, synthetic, braided suture, manufactured by Ethicon Inc., a subsidiary of Johnson and Johnson. It is indicated for soft tissue approximation and ligation. The suture holds its tensile strength for approximately three to four weeks in tissue, and is completely absorbed by...
and polydioxanone
Polydioxanone
Polydioxanone or poly-p-dioxanone is a colorless, crystalline, biodegradable synthetic polymer.-Chemistry:Chemically, polydioxanone is a polymer of multiple repeating ether-ester units. It is obtained by ring-opening polymerization of the monomer p-dioxanone...
. It is not used at all for human surgery in some countries. In Europe and Japan, gut sutures have been banned due to concerns that they could transmit bovine spongiform encephalopathy
Bovine spongiform encephalopathy
Bovine spongiform encephalopathy , commonly known as mad-cow disease, is a fatal neurodegenerative disease in cattle that causes a spongy degeneration in the brain and spinal cord. BSE has a long incubation period, about 30 months to 8 years, usually affecting adult cattle at a peak age onset of...
(mad-cow disease), although the herds from which gut is harvested are certified BSE-free.
History
The first known absorbable sutures were made of the intestineIntestine
In human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
s of sheep. The manufacturing process was similar to that of natural musical strings for violin
Violin
The violin is a string instrument, usually with four strings tuned in perfect fifths. It is the smallest, highest-pitched member of the violin family of string instruments, which includes the viola and cello....
s and guitar
Guitar
The guitar is a plucked string instrument, usually played with fingers or a pick. The guitar consists of a body with a rigid neck to which the strings, generally six in number, are attached. Guitars are traditionally constructed of various woods and strung with animal gut or, more recently, with...
, and also of natural strings for tennis racquets. Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
was the first to use gut strings for medical sutures.
Manufacture
Catgut suture is made by twisting together strands of purified collagenCollagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
taken from bovine intestine
Intestine
In human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
s. The natural plain thread is precision ground in order to achieve a monofilament
Monofilament
A monofilament may be:* Monofilament fishing line, a type of thread* A monofilament as used in a monofilament test in a neurological examination* Monomolecular wire, a fictional type of wire consisting of a single strand of molecules...
character and treated with a glycerol
Glycerol
Glycerol is a simple polyol compound. It is a colorless, odorless, viscous liquid that is widely used in pharmaceutical formulations. Glycerol has three hydroxyl groups that are responsible for its solubility in water and its hygroscopic nature. The glycerol backbone is central to all lipids...
-containing solution. The suture is sterilized with ethylene oxide
Ethylene oxide
Ethylene oxide, also called oxirane, is the organic compound with the formula . It is a cyclic ether. This means that it is composed of two alkyl groups attached to an oxygen atom in a cyclic shape . This colorless flammable gas with a faintly sweet odor is the simplest epoxide, a three-membered...
gas, is straw-colored, and is available in sizes USP 6-0 (1 metric) to USP 3 (7 metric).
Although the name implies the usage of guts of cats, there is no record of feline guts being used for this purpose.
Variants
Chromic catgut suture is a variant treated with chromic acidChromic acid
The term chromic acid is usually used for a mixture made by adding concentrated sulfuric acid to a dichromate, which may contain a variety of compounds, including solid chromium trioxide. This kind of chromic acid may be used as a cleaning mixture for glass. Chromic acid may also refer to the...
salts. This treatment produces roughly twice the stitch-holding time of plain catgut, but greater tissue inflammation occurs. Full tensile strength
Tensile strength
Ultimate tensile strength , often shortened to tensile strength or ultimate strength, is the maximum stress that a material can withstand while being stretched or pulled before necking, which is when the specimen's cross-section starts to significantly contract...
is extended to 18–21 days. It is brown rather than straw-colored, and has improved smoothness due to the dry presentation of the thread (plain catgut is wet). It is otherwise similar to plain catgut.
Fast catgut suture is heat-treated to give even more rapid absorption in the body.