There are several different suture materials used for the precise and safe closure of wounds. However, the choice of suture material should be based on the biological interaction of the materials used, the configuration of the tissue, and the biomechanical properties of the wound. An example of a suture that can be used in such cases is the 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 that is obtained when glycol is reacted with a dibasic acid. Polyesters are long chains with a high molecular weight and aromatic rings that are repeated over and over 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 that became known to last an indefinite period in tissues. Its acceptance in surgery was initially limited to a small section because the suture had a high coefficient of friction. This used to get in the way of passing through the weave and made it difficult to construct a knot. However, with the increase in scientific technology, it soon became known that these sutures could be coated with a lubricant. Therefore, Ethibond sutures gained wide acceptance in surgery. This coating markedly reduced the coefficient of friction of the suture, thus aiding in knot formation and passage through tissue. All TiCron polyester sutures are coated with silicone, while the surface lubricant for Surgidac is polybutylene adipate. Because some surgeons like to tie sutures with a high coefficient of friction, Surgidac sutures can also be obtained without a surface coating.
Ethibond Excel sutures are uniformly coated with polybutylate, a non-absorbable, biologically reactive compound that adheres to braided polyester fiber yarn. This was the first synthetic coating developed specifically as a lubricant for surgical sutures. The coating facilitates the passage of the braided threads through the fabric and provides excellent flexibility, handling qualities and smooth tying with each pull of the knot. Both the suture material and the coating are pharmacologically inactive. The sutures elicit 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 of two organs or vessels that are usually hollow, so any preferred brand of polyester suture will work wonderfully in valve replacement procedures around the world.
Ethibond Excel is available in two forms, green when tinted and white when untinted. Ethibond Excel sutures are also available attached to TFE polymer felt pads. These are small, flat absorbent pads that are used to medicate, drain, salvage a wound, or serve to postpone potential tearing of adjacent friable tissue. They are used regularly in valve replacement procedures. This is to prevent the ring from breaking when the prosthetic valve is seated and the sutures are tied. They are also used in situations where extreme tissue deformity, distortion, or destruction has occurred.
