Prolene: The Gold Standard for Permanent Surgical Closure
Prolene, manufactured by Ethicon, a subsidiary of Johnson & Johnson, is a synthetic, non-absorbable surgical suture composed of an isotactic crystalline steroisomer of polypropylene. Unlike absorbable sutures that dissolve over time, Prolene is designed to remain in the body indefinitely, providing long-term strength and support to the wound site. Its monofilament structure means it is a single, smooth strand, which allows it to glide through tissue with minimal drag, reducing trauma and the risk of infection. This exceptional material is a mainstay in procedures where dependable, permanent tissue approximation is paramount.
Cardiovascular and Vascular Surgery
Perhaps the most prominent use of Prolene is in cardiovascular and vascular surgery, where its reliability is critical for patient safety. Its ability to retain tensile strength over time, with no biodegradation, has made it the primary choice for vascular anastomoses—the surgical connection of two hollow or tubular structures.
Coronary Artery Bypass Grafting (CABG)
- Blood Vessel Closure: Surgeons use Prolene to precisely and securely sew blood vessels together during bypass procedures, ensuring a watertight and durable connection for the long term.
- Small Vessel Repair: The availability of extremely fine-gauge Prolene sutures allows for delicate work on smaller vessels, crucial for complex cardiac procedures.
Aortic and Large Vessel Repair
- Anastomosis of Grafts: For large-scale repairs involving the aorta or other major vessels, Prolene is used to attach synthetic grafts, a procedure where long-term suture integrity is a must.
- Prevention of False Aneurysms: Its non-degradable nature helps prevent suture fracture, which could lead to complications like false aneurysm formation.
Neurological and Ophthalmic Procedures
The monofilament, low-reactive nature of Prolene also makes it an excellent choice for delicate and sensitive tissues found in the fields of neurology and ophthalmology. In these surgeries, minimal irritation and precise placement are key to a successful outcome.
- Neurosurgery: Used for soft tissue approximation and ligation within the central nervous system where a permanent, inert suture is required.
- Dural Repair: For repairing the dura mater, the tough membrane covering the brain and spinal cord, Prolene provides the necessary strength and low reactivity.
- Ophthalmic Surgery: The very fine sizes available (down to 10-0) are perfect for intricate eye surgeries, including corneal and scleral repairs.
General Surgery and Hernia Repair
In general surgery, Prolene's robust qualities are leveraged for repairing areas under high tension, particularly those requiring permanent support to prevent recurrence.
- Hernia Repair: Polypropylene mesh, a form of Prolene, is frequently used to provide structural reinforcement during hernia repair. Prolene sutures are used to secure the mesh to the surrounding fascia, offering permanent support to a weakened abdominal wall.
- Fascial Closure: In procedures like repeat C-sections, Prolene is used to suture the rectus sheath, a fascial layer of the abdominal wall. Its permanent tensile strength ensures the abdominal wall remains strong and intact over time.
- Soft Tissue Ligation: It is also used for general soft tissue approximation and ligation, securing tissues and blood vessels where long-term integrity is crucial.
Comparison of Suture Materials: Prolene vs. Alternatives
Choosing the right suture depends on the specific surgical goals and tissue characteristics. Prolene is often compared to other common materials like Vicryl (an absorbable) and Nylon (another non-absorbable). Here is a comparison:
| Feature | Prolene (Polypropylene) | Vicryl (Polyglactin 910) | Nylon (Polyamide) |
|---|---|---|---|
| Absorbability | Non-absorbable | Absorbable (60–90 days) | Non-absorbable (loses strength over time) |
| Structure | Monofilament | Braided multifilament | Monofilament |
| Tissue Reaction | Very low | Low (can be coated) | Low (slightly more than Prolene) |
| Handling | Slippery, requires careful knotting | Excellent, good knot security | Stiff but easier than Prolene |
| Tensile Strength | Permanent retention | Good for 2–3 weeks | Loses strength over time |
| Primary Use Cases | Vascular surgery, hernia repair, areas needing permanent strength | Internal closures, muscle layers, mucosal repairs | Skin closure, orthopedic, tendon repair |
Dermatological and Cosmetic Applications
The smooth, monofilament surface of Prolene makes it a favorite for closing skin in dermatological and cosmetic surgeries. It slides through the skin with less friction than braided sutures, leading to less tissue trauma and potentially better cosmetic outcomes. Because it is non-absorbable, it must be removed after the skin has healed, typically around 7-14 days depending on the location.
Conclusion
Prolene suture's non-absorbable, monofilament nature and high tensile strength make it a uniquely valuable tool in the surgeon's arsenal. From the delicate work of ophthalmic and neurosurgery to the high-stakes demands of cardiovascular and hernia repair, Prolene provides reliable, permanent tissue support. While alternatives exist for different applications, Prolene's combination of inertness, strength, and smooth passage through tissue ensures its continued importance in a wide range of surgical disciplines. For further reading on suture materials, including comparative information, the National Institutes of Health (NIH) provides a comprehensive resource: Sutures and Needles - StatPearls - NCBI Bookshelf.
