Non-Absorbable Inorganic Suture Materials Or Metallic Sutures
These are non-absorbable, monofilament or braided/twisted multifilament sutures. Wires of different metals like tantalum, silver, copper, stainless steel or vitallium are used in monofilament or multifilament form as suture material. Use of metallic sutures is not new. It has been centuries since when wires of metals like lead, gold and silver were being used by surgeons. They are used as implants or along with implants most of the time and not removed in general except skin.
1. Tantalum
It is a rare metal, inert to tissues like stainless steel. Foil is used in surgical procedures. Monofilament wire is commonly used in sizes ranging from 4 to 6/0.
Most commonly used in neurological anastmosis and also have been used in kidney resection, gastric resection surgeries, rhinoplastic surgeries, hernioplasties, vessel anastmosis etc.
Fig: Tantalum Wire (By Steelo Fabrica)
2. Silver Wire
Silver wires and other forms are used to some extent as suture material. It has some antiseptic properties but it becomes ionized in tissues and can cause inflammation/irritation.
(To enhance antibacterial properties of regular suture threads they are also treated with silver). Less commonly used in modern day surgery but in ancient times it has been used.
3. Copper Wire
It is more suitable to repair fractures due to its flexibility. It has better knotting ability than aluminium but also obsolete and out of trend now.
Fig: Copper wire for surgical use by PeierTech
4. Aluminium wire
It is more flexible than stainless steel. But not used in recent trends.
5. Vitallium
It is a cobalt-chromium-molybdenum (Co-27Cr-5.5Mo-2.5Ni-0.25C) alloy that has characteristics like stainless steel and is applicable surfaces. It is wear-resistant and has excellent tensile strength. The Michel wound clips are applied with a special in situations where stainless steel sutures can be used. it is mainly used in dentistry and orthopedic procedures.
What is vitallium used for?
Vitallium is a mixed alloy like stainless steel and mainly used in making prosthesis in dentistry and orthopedics due to its resistance to corrosion.
Is vitallium a titanium?
No. Vitallium is different from titanium. But has similar tensile strength like vitallium.
Fig: Stryker Dall-Miles Vitallium Trochantric Grip Plate(Small) with two 2.0 mm cables
6. Metal clips (Wound clips)
They hold the skin in apposition over flat forceps quickly. They cause less scarring and less reactive. It is easy to use, fast and efficient in wound closure.
It provides maximum holding force with minimal tissue and animal trauma. It can be autoclaved and also reduces the incidence of infection.
Fig: Reflex Autoclip System by AgnThos
Absorbable metal clips as substitute for ligatures and deep sutures in wound closure also have been used. The animal can remove them easily and are not suited for Veterinary Surgery. They are more expensive than traditional sutures and require proper placement with care.
Eg. Autoclip wound closures, EZ clip wound closure, Reflex wound closures, Michel wound closures, Hegenbarth wound closures, Replacement wound closure clips etc
What are wound clips?
Wound clips are wound closure device for fast wound closure and reduces the chances of infections.
What are wound clips used for?
Wound clips are used to close wounds or surgical incisions that are complex or too big to close with traditional stitches.
How do medical staples work?
Medical staples hold the wound edges together. They causes less trauma and reduces inflammatory response.
Fig: Covidien Appose Skin Stapler
7. Pin Suture
Ordinary pins can be used for keeping the skin edges together. Skin stapler is used to apply staple pins.
Usually wound clips and pins are made of stainless steel. Staples are of two sizes regular and wide.
8. Wire Mesh
Tantalum and stainless steel mesh are used to cover defects in the abdominal wall in cases of hernia or injury. The tissues grow through the meshes of wire and provide a good strength. They are attached with staples, stitches or glue. Pore size is the main determinant of tissue reaction elicited.
Fig: Hernia mesh by Rhythm Surgicals
9. Stainless Steel Suture
These are made of 316L and used in sternum closure, orthopedic procedures and hernia repair.
Recent trends are in favour of biodegradable metals for medical sutures. These biodegradable alloys are made of iron, zinc and magnesium.
Indications of Metallic Sutures and Meshes:
Ophthalmic microsurgeries, maxillofacial surgeries, neurosurgery, sternum closure, orthopaedic procedures, hernia repair etc.
Limitations / Disadvantages:
- Poor knotting ability
- Stiffness and suture memory
- Tear through tissues
- MRI like techniques can’t be performed in patients with metallic sutures or implants.
Advantages:
- Exceptionally high tensile strength (strongest)
- Less complications (operative and postoperative)
- Well tolerated, minimum chances of rejection
- Biologically inactive/inert
- Least reactive / least tissue reaction
- Can be left in situ for indefinite period of time
- Free of toxins
- Easy to sterilize
- Flexible
- Extreme knot security
Complications:
- Chronic suppurating sinuses
- Organ or tissue Perforations
- Pain and Discomfort
- Bleeding and infections
- Adhesions
- Implant failure
FAQs:
Do stitches have metal in them?
Not all the stitches are metallic but according to need metal staples or metallic wires or meshes can be used.
What are metallic sutures?
Metallic sutures are suture materials made of metals like silver, stainless steel, copper etc.
Metal stitches hurt coming out?
Metal staples on the skin can cause a tugging sensation during removal and shouldn’t hurt at all. Their removal doesn’t need anaesthesia. Special removing tools are needed and should not be tried to remove at home.