What Exactly Are Ethibond Sutures?
Ethibond sutures are a type of surgical suture manufactured by Ethicon, a Johnson & Johnson company, and are widely used in medical procedures. The "Ethibond Excel" suture is a braided, sterile, and non-absorbable material composed of poly(ethylene terephthalate), a high molecular weight, long-chain linear polyester. This is essentially the same polymer used to make fabrics like Dacron. The suture is braided for optimal handling and excellent knot security, and it is uniformly coated with a relatively non-reactive compound to act as a lubricant. This coating allows for smooth passage through tissue and minimizes the risks associated with the high friction of an uncoated braided material. For enhanced visibility in the surgical field, the suture is typically dyed green.
The Straight Answer: No, Ethibond Sutures Do Not Dissolve
The most important takeaway for anyone concerned with Ethibond is that they are designed to be permanent. Unlike absorbable sutures, such as Vicryl, which are engineered to break down and be absorbed by the body's tissues over a set period, Ethibond maintains its tensile strength indefinitely. The polyester material is not affected by enzymatic digestion within the body, making it a reliable choice for long-term or permanent tissue approximation. When used internally, the body's immune response will eventually encapsulate the suture material in scar tissue, effectively walling it off without the suture itself degrading.
Why Would a Surgeon Choose a Non-Dissolving Suture?
The permanence and high tensile strength of Ethibond are not drawbacks but key features that make it the ideal choice for specific surgical applications. Surgeons use non-absorbable sutures when they need to provide long-term or permanent support to tissues that heal very slowly or are under high stress. Common applications include:
- Cardiovascular Surgery: Used for delicate procedures like coronary artery bypass grafts and valve replacements.
- Orthopedic Procedures: Used to repair ligaments, tendons, and fractures, as seen in the Suture Bridge technique for infrapatellar fractures.
- Abdominal Wall and Fascial Closures: Provides strong, long-lasting support for abdominal wall repair.
- Nerve Repair: Offers precise and lasting support for delicate nerve tissue.
Ethibond vs. Absorbable Sutures: A Quick Comparison
To better understand the function of Ethibond, it is helpful to compare it directly with its absorbable counterparts.
| Feature | Ethibond (Non-Absorbable) | Absorbable Sutures (e.g., Vicryl) |
|---|---|---|
| Material | Braided polyester (polyethylene terephthalate) | Synthetic polymers, animal gut, or other materials |
| Lifespan | Indefinite; remains permanently encapsulated in tissue | Absorbed by the body over a specified time period (e.g., weeks to months) |
| Strength | High, long-term tensile strength | Decreases over time as material is absorbed |
| Removal | Requires manual removal if used externally | Does not require removal; dissolves naturally |
| Primary Use | High-tension areas, long-term tissue support (cardiac, orthopedic) | Soft tissue approximation, areas where temporary support is needed |
| Coating | Coated to reduce friction | May be coated for improved handling |
The Removal Process for External Ethibond Sutures
Because Ethibond is permanent, any sutures used for external skin closure must be removed by a healthcare professional at the appropriate time. Attempting to remove stitches yourself can lead to incomplete removal, infection, or wound dehiscence (reopening). The removal process is generally quick and painless, involving these steps:
- Preparation: The site is cleaned with an antiseptic solution.
- Grasping the Knot: Using sterile forceps, the doctor or nurse will gently lift the knot of the suture away from the skin.
- Cutting the Suture: The suture is cut with sterile scissors as close to the skin as possible to avoid pulling contaminated thread through the wound.
- Pulling the Thread: The thread is gently pulled out from the skin in one continuous motion.
- Post-Removal Care: The wound is cleaned again, and an adhesive strip or bandage may be applied for continued protection.
Risks and Considerations
While generally safe, the use of Ethibond and other non-absorbable sutures carries certain risks, especially when used in ways not intended for them. The most common issues include:
- Risk of Infection: As a braided, multifilament suture, Ethibond can have higher risk of infection compared to monofilament sutures, as bacteria can potentially colonize in the grooves of the braid.
- Suture Sinus Formation: If a buried suture is not properly walled off, a small tract or sinus can form to the skin's surface, which may require removal of the suture to resolve.
- Foreign Body Reaction: While polyester is relatively non-reactive, any permanent foreign material in the body can cause a tissue reaction.
- Palpability: Internally placed sutures can sometimes be felt or cause discomfort if they are too close to the surface, which is why they are not used in cosmetically sensitive areas.
Understanding the purpose and permanence of Ethibond sutures is crucial for any patient undergoing surgery with this material. For more detailed information on surgical procedures and patient care, consult with your healthcare provider or refer to reliable medical resources, like the National Institutes of Health.
