|Year : 1979 | Volume
| Issue : 3 | Page : 24-28
Vicryl suture in ophthalmic surgery
Madan Mohan, SK Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., Ansari Nagar, New Delhi-110016, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences A.I.I.M.S., Ansari Nagar, New Delhi-110016
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mohan M, Angra S K. Vicryl suture in ophthalmic surgery. Indian J Ophthalmol 1979;27:24-8
The advent of fine synthetic absorbable sutures for ophthalmic surgery gave a new dimension to the surgical procedures in obviating the hazards of removal of sutures, which are as dangerous as the surgical procedure itself. It has made the tissue devoid of allergic reactions seen in non-synthetic absorbable sutures and avoid subsequent visit to the clinic for suture removal. The long term irritation of embedded sutures is avoided too.
Vicryl (Polyglactin 910) synthetic absorbable suture is prepared from a co-polymer of glycolide and lactide, which are derived from glycolic acid and lactic acid. These sutures are claimed to be inert, non-antigenic and non-pyrogenie. Besides, these elicit a mild tissue reaction during absorption and are dispensed in sterile packing. These sutures are braided for optimum strength and handling properties.
An endeavour has been made in this study to evaluate the Vicryl (Polyglactin 910) suture in various ophthalmic surgical procedures.
| Methods and Material|| |
Vicryl suture was used in various surgical procedures, [Table - 1][Table - 2]. The handling properties of the sutures and suture induced post-operative reactions were noted [Table - 3].
| Observations|| |
A. These patients were followed for various complications and reactions pertaining to suture material [Table - 3]. It was found in corneoscleral suturing that the localised conjunctival oedema around the sutures was seen in 6.4% in exteriorised sutures and 7.3% in buried sutures when used in cataract cases. The rate of fall of sutures was 6.3% when exteriorised (of Virgin Silk 3.2%) while no buried corneoscleral suture eroded the conjunctiva. Mild conjunctival reaction persisted around the suture till absorption.
The healing of the wound was not affected in any way by the sutures. No hypertrophy of the conjunctival and corneal scar tissue was noted.
In entropion cases skin sutures were removed on 10th day as the oedema around sutures peristed.
B. Handling properties of the Suture:
There was no handling difficulty with or without a miscroscope. The visibility was better in violet dyed sutures. When reaction to the suture was compared, there was no difference between the dyed and undyed ones. The needle GS-9 was found superior to G-6, while S-14 needle was found suitable for squint surgery as well as for muscle and skin suturing in entropion cases. Knot tying was problematic. A double or triple throw was put in first tie [Figure - 1] and judging the proper tension, further ties were put. We cut the sutures very close to the knots and in some cases heat cautery to the suture was applied which made the knot shrink. This reduced the bulk of the knot chances of slippage of sutures and opening of knots. There was very little tendency for tissue drag. This was obviated by immersing the suture in saline for 5 mts prior to usage.
| Discussion|| |
The ideal characteristics of a suture cannot be achieved in one suture. However, with absorable synthetic suture, Vicryl (Polyglactin 910) has fulfilled many of the ideals which could not be achieved by the use of either non-absorbable or non-synthetic absorbable sutures. The handling properties with this suture are satisfactory except knot tying which when carefully put, is also satisfactory. The braided character did not give gritty sensation. There is no knot slippage. The ends tend to stand out. This was obviated by cutting the sutures very close to the knot and by applying gentle cautery to the suture cut ends and even to the knot. This avoids irritation, knot slippage and shrinks the knot to a smaller size. The ideal sutures with this are buried sutures. In that we support the view of Croll & Croll. The knots are to be pulled to the scleral side to avoid corneal erosion due to knot pressure. We did not note the hypertrophy, of the scar as has been seen in 50% of skin sutures. The suture size of 7/0 is ideal as the more finer and monofilament suture are stiff and cut though the tissue, Bartholomew et all, Blaydes.
There was no significant higher complications as compared to controls. The average absorption time with 7/0 suture in our cases is 40 days and with 6/0 suture is 50 days. We agree with Bartholomew et al that the absorption of suture depends on blood supply and temperature of the tissue i.e. inflammation causes early absorption. This average absorption rate in their cases was 56 days. We did not support views of Faulboon and Theobald that vicryl is not reliable for more than 2 weeks.
| Summary|| |
A new synthetic suture Vicryl (Polyglactin 910) is evaluated for ophthalmic use.
| Acknowledgement|| |
We acknowledge with thanks the Vicryl (Polyglactin 910) Suture supplied by M/S Ethicon Division of Johnson & Johnson Ltd. Bombay.
| References|| |
Bartholomew R.S., Phillipe C.T. and Munton C.G.F., 1976, Brit. Jour. Ophrhal., 60,
Blaydes J.E., 1977, High li;hts of Ophthal., 5, 3,
p. 1. Series. ed. Beryanin Boyd.
Cox A.G. and Simpson J.E.P., 1975, Lancet, 1,
Croll, M. and Croll J.L., 1977, Ann. Ophthal. (Chic)
Dunphy J.E. and Jackson D.S., 1962, Amer. Jour. Surg.
Faulbon, J. and Theobald H. 1977, Klin. Mbl. Augenhelik.,
Munton C.G.F., Phillips, B., Martin B. Bartholomew R.S. & Capperauld 1., 1974, Brit. Jour. Ophthal., 58,
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3]