Composition
Polydioxanone/PDS / PDS II or poly-p-dioxanone suture is a slowly absorbable, strong, synthetic, crystalline, monofilament homo-polymer of 100 % polydioxanone (ether – ester). These sutures are uncoated. PDS suture material was the first synthetic absorbable monofilament suture.
Handling
It is more flexible than polyglycolic acid and polyglactin 910. It has minimal tissue drag, good flexibility and handling qualities but larger sizes are stiff which have tendency to coil or “pig-tail”. PDS II is updated version of PDS monofilament suture and has improved handling.
Knot security
More smooth finish of monofilament has an advantage of less tissue drag but also decreases handling (more difficult to handle than Dexon or Vircyl suture) and knot security relatively. Knot security is reasonable at least 4 throws are recommended for a secured knot. For continuous suture patterns 5 throws at start and 6-7 throws at end of pattern should be preferred. It is sterilised by ethylene oxide.
Tensile strength
PDS monofilament suture has greater strength than nylon monofilament suture and polyproplylene monofilament suture. But it is less than braided polyfilaments like Polyglactin 910 and PGA sutures. Polydioxanone suture material retains approx. 70-80% of initial tensile strength after 14 days and more than 50% tensile strength is retained after 6 weeks of implantation so provides extended wound support up to 6 weeks.
Absorption
Polydioxanone, like polyglycolic acid and polyglactin 910, is absorbed by non-enzymatic hydrolysis (degraded into 2 hydroxyethoxyacetic acid – excreted through urine) and complete absorption takes place between 91 to 182 days/ up to 6 months. Absorption is predictable and reliable with PDS suture.
Tissue reaction
It is non-antigenic, non-pyrogenic and incites little tissue reaction during the absorption process.
Fig: Duracryl – PDS suture by dolphin sutures – Violet colored (uncoated)
Fig. Ethicon PDS II suture – Type of polydioxanone Suture
Advantage
Tensile strength of PDS 2 or polydioxanone sutures is maintained in alkaline environment and it makes them suitable for use in biliary and urinary tract surgeries. It is recommended when prolonged tissue support is desired. It causes lesser tissue drag and decreased scar spreading. It has minimal memory and does not support infection and maintains integrity in the infected tissue.
Indications
PDS sutures are popular choice for general soft tissue surgeries, subcuticular closures, oncology, geriatric / immunocompromised patient surgeries, gastrointestinal surgeries (anastmoses, abdominal wall closure), general orthopaedic surgeries, joint muscle approximation, hard tissue approximation, ophthalmic surgeries, maxillofacial surgeries, paediatric surgeries, cardiovascular surgeries, ligament – tendon repair, plastic surgeries, and fascia closure.
In animals PDS suture use can be preferred in the linea alba closures, hernial repairs and pexy procedures.
Contraindications
PDS II suture should not be used with prosthetic devices like heart valves or synthetic grafts. Its use is also warned in adult patients for microsurgery and neural approximation. It should be avoided using in patients with known history of hypersensitivity to PDS. Its long retention period may increase the chances of calculus formation in patients having history of urinary calculi formation. PDS suture should not be used where extended support beyond 6 weeks is required.
PDS Suture Sizes
Available in various USP gauze sizes ranging from 2 to 6-0 without or with needles of different types, sizes and shapes (Round bodied, cutting edge, taper point, straight, blunt point) and suture lengths. It comes in aluminium foil packages. *Diameter of PDS is followed from British Pharmacopoeia.
Storage
General suture handling precautions should be followed and should be stored between 10oC-35°C in dry conditions. Shelf life is upto 3 years for PDS suture.
Antibacterial Polydioxanone (PDS) Suture
e.g. PDS Plus Antibacterial suture is polydioxanone monofilament suture material coated with triclosan which is an antibacterial agent. It is needed when extended wound support is required. It helps in the inhibition of bacterial colonization on suture. It helps in minimizing the pain associated with subclinical infection at suture site due to surgical site infections.
Fig: PDS plus antibacterial polydioxanone monofilament suture by Ethicon
PDS or Polydioxanone is an absorbable synthetic homopolymer made of 100/5 polydioxanone (ether- ester). It has more tensile strength than PGA and Polyglactin 910 suture.
Yes. PDS II (polydioxanone suture) is absorbable synthetic suture material and it is the first in synthetic absorbable monofilaments. But has the poorest knot security among synthetic absorbable sutures.
PDS II (polydioxanone) Suture is indicated in variety of surgical procedures like general soft tissue surgeries, subcuticular closures, oncology, geriatric / immunocompromised patient surgeries, gastrointestinal surgeries (anastmoses, abdominal wall closure), general orthopaedic surgeries, joint muscle approximation, hard tissue approximation, ophthalmic surgeries, maxillofacial surgeries, paediatric surgeries, cardiovascular surgeries, ligament – tendon repair, plastic surgeries, and fascia closure.
Polydioxanone is the least reactive suture material and doesn’t support surgical site infection. It provides extended support more than 6 weeks in the area of infection.
Polydioxanone or PDS II sute is a synthetic homopolymer, absorbable, monofilament suture made from paradioxanone/ Polydioxanone. It is dyed not coated. Looped/Loop PDS suture is also available.