ABSORBABLE MONOFILAMENT ?

Yes !

Why ?

Why use a Monofilament?

1. Less infection promoting effect

2

Scientific Evidence – General Surgery

Results: Experiment 1 : No bacterial growth in the monofilament and antibiotic-coated sutureExperiment 2 : Average E.Coli colony from - monofilament suture 0±0, antibiotics-coated Polyglactin 39.3±14.4, Polyglactin 208.6±76.6, Silk 59.4±26.7

Conclusion:

(J Korean Surg Soc 2009;77:1-6)

“Monofilament suture showed a significantly lower level

of bacterial infiltration and colonization”²

Dept of Surgery School of Medicine, Daegu Catholic University, Daegu, Korea (2009)Hyuk-Jae Choi M.D, Hyun-Dong Chae M.D

Different Structure/ Different properties

Monofilament vs Braided Structure

Monofilament1. Single strand of material (extruded) 2. Smooth Surface (less tissue drag) 3. No internal spaces to harbour bacterial

growth (compared to braided filaments)

4

Multifilament/ Braided1. Several strands of material twisted

together.2. Normally coated to reduced tissue

drag (higher frictional coefficient)3. Bacteria can easily established

within the braided material (due to suture structure with internal spaces and capilarity)

Why use a Monofilament?2. Smooth passage thought the tissue

USP 1USP 0

USP 2/0

0123456789

Novosyn

Safil

Monosyn

1.Thanks to the longitudinal elasticity monofilament provide:2.Easy and safe knotting behavior3.Ideal adaptation to any sudden movements of the wound

5

Knot pull tensile strength higher than Braided sutures*:

* Data on file

Kgf

Short term synthetic absorbable sutures

Kgf

Mid term synthetic absorbable sutures

USP 1 USP 0 USP 2/00

1

2

3

4

5

6

7

Safil Quick

Monosyn Quick

Why use a Monofilament?3. Secure knot and high knot tensile strength

“Monofilament suture material is finer and is associated with less tissue damage compared with braided structure” ²

6

( 2)Hyuk-Jae Choi, M.D., Hyun-Dong Chae, M.D. Comparison of E. coli Infiltration between New Synthetic Absorbable Sutures. J Korean Surg Soc 2009;77:1-6

MonosynBiosyn

Monocryl

Safil

Vicryl

0.0200000000000001

0.0270000000000004

0.0300000000000001

0.0400000000000001

0.0500000000000001Tissue Drag (Kgf)

Monofilament•Smooth Surface•less tissue drag

Braided: •Higher frictional coefficient•Higher tissue drag •Normally coated (to reduce tissue drag)

Why use a Monofilament?2. Smooth passage thought the tissue

Monosyn Safil Vicryl

0.02

0.04

0.05

Tissue drag

Native suture materialstrigger real allergies and cause massive tissue reactions (processed animal products are incorporated in the patient).Now prohibited in the European marketBraided synthetic, absorbable suture materialscause stronger reactions in the tissue, due to tissue trauma (saw effect) and increased spread of germs through capillarity (“Wick effect”).Monofil synthetic, absorbable suture materialscause little tissue reaction; no germ transport. NO WICK EFFECT! The B.Braun products offer the additional advantage of longitudinal elasticity, meaning: The suture stretches before it can traumatize the tissue (rubber band effect).Braided, non-absorbable synthetic suture materialsalways cause stronger tissue reactions because of wick effect and tissue trauma (saw effect). There is a permanent foreign-body reaction.Monofil suture materialsalso trigger permanent foreign-body reactions. Advantage: neither saw nor wick effect.The above points are the main reasons why, generally, no non-absorbable suture material should be recommended for abdominal wail closure (general experience over the past decades in practical, clinical application). Negative effects of these products: SEROMAS; FISTULAS; GRANULOMAS!!! (applies to sutures from any manufacturer)

•CATGUT CHROME*•CATGUT PLAIN *•SILK *•TWINE *•POLYESTER * (braided, uncoated)•POLYESTER * (braided, coated)•POLYAMID * (braided, coated)•Synthetic absorbable (braided, coated)•Synthetic absorbable (monofil.)•Polyamide (monofil.)•Polypropylene (monofil.)•Steel wire (monofil.)•Titanium (inert)

Tissue reaction

Degradation profile adapted to the wound healing process

of each tissue

8

Fast healing tissue

SkinMucosa

Use the most suitable suture for every surgical layerB. Braun Closure Technologies offers a complete Synthetic Monofilament Suture portfolio.In order to fulfill every surgeons need, we provide the entire absorption profile range for the closure of the main surgical layers.

Monosyn® Quick

Monosyn®

Monoplus®

Monomax®

Time needed to reach 50% of initial tensile strength (in days)

ı7

ı14

ı28

ı90

Soft tissueSubcutaneous fatVagina – UterusBladder – UreterDigestive tract

Long term healing tissueFasciaTendonsLigaments

Abdominal Wall