Composition
Polypropylene is a synthetic, nonabsorbable suture, a monofilament 100% homo-polymer of propylene derived from propane gas (clear or pigmented blue forms). It is an isotactic crystalline stereoisomer of synthetic polyolefin/propylene. These are popularly known as Prolene sutures.
Tensile strength & Knot Security
Polypropylene sutures retain tensile strength for indefinite time in vivo. It has uniform diameter with high tensile strength and high knot strength among synthetic monofilament sutures. It does not elongate while knotting which makes it ideal for knot security. But require additional throws to secure a knot. Polypropylene sutures has high plasticity and difficult in handling in comparison to nylon sutures. It doesn’t adhere to the tissue and removal is smooth.
Tissue reaction
It has smooth texture and minimal tissue drag. Polypropylene is inert, incites minimal tissue reaction, but it is slippery and need practice for easy handling. They get encapsulated by fibrous connective tissue.
Absorption
Polypropylene sutures are neither absorbed nor hydrolysed by the body tissue so this biological inertness can minimize later sinus formation and suture extrusion. It remains unaffected by blood, tissues and body enzymes. Lack of adherence to the body tissue makes them easy to pull during suture removal.
Indications
Polypropylene sutures are used both in human and veterinary practice.
Due to high flexibility, it can be used in general soft tissue approximating and/or ligation, ophthalmic procedures (Cataract Surgery, Orbit and Oculoplasty Surgery), orthopaedic surgeries, neurological procedures, gynaecological procedures, dental surgeries, herniorrhaphy, on the skin, cardiovascular surgeries (Distal and Proximal Anastomosis, Atrial Septal Defect/ Ventricular Septal Defect, Cannulation), peripheral vascular surgeries (A/V Fistula, Carotid Endarterectomy), plastic and microsurgeries (Microsurgical anastomosis, Brachial plexus injuries, Onco Reconstruction surgeries, Faciomaxillary, Hand injury and Tendon Repair). Prolonged tensile strength in infected wounds makes it suitable for use in repair infected/contaminated wounds.
Polypropylene is useful and popular in cardiovascular surgery because it is non-thrombogenic, and supports the heart’s propulsion.
Its monofilamentous nature does not support bacterial growth and provide permanent wound support in case of permanent fixtures in cardiovascular and plastic surgeries. It is least likely to potentiate infection or induce thrombi when implanted.
Contraindications
Use of polypropylene suture is contraindicated in case of known history of sensitivities or allergies to polypropylene. Local irritation and transitory inflammatory foreign body response can be seen. Not recommended for synthetic anastomoses (graft to graft).
Colour & Sizes
They are generally dyed blue in colour (not coated) with phthalocyanine blue for easy identification during surgical procedures. Polypropylene sutures are either dyed blue in colour or undyed clear in color. Available in 2 to 10-0 sizes with different thread lengths, needle shapes, lengths, and types. Polypropylene sutures are also available with specialized needles or as spools by some manufacturers.
Fig: Prolene 10-0 – Polypropulene suture material by Ethicon
Fig: Prolene 6-0 – Polypropylene suture material by Ethicon
Storage
It is sterilized by ethylene oxide. Can be stored easily between 10oC-35°C in dry conditions.
Resterilization, reuse and reprocessing is not recommended. Shelf life of prolene sutures is up to 5 years.
Examples
Prolene by Ethicon, Unilene by Universal Sutures, Fialprop by Meril Sutures, Prolus by Lotus Suture, Duracare by Dolphin Sutures
# Specialized Polypropylene Sutures
#PROLENE Polypropylene Suture with HEMO-SEAL- It is a needle suture combination which reduces needle hole bleeding and helps in better visualization of the surgical site during bite placement.
# Poly (hexafluoropropylene-Vinylidene Fluoride) Sutures
Eg. Pronova suture – It is a nonabsorbable monofilament suture made from vinylidene fluoride and vinylidene fluoride-co-hexafluoropropylene. It is available in pigmented blue form for better visibility.
It is indicated for use in cardiovascular, ophthalmic, neurological procedures and general soft tissue approximation /ligation.
# Polypropylene surgical mesh
Polypropylene surgical mesh is smooth, flexible, non-absorbable synthetic mesh used for hernial repair, tension-free abdominal/laparoscopic closures, or permanent support for weak tissues. It is also known as hernia mesh. Usually, meshes come in a variety of shapes, pore sizes, thickness, knitting patterns, dimensions (eg. 2×2, 3×6, 6×6, and 12×12 inches), and bursting strength.
These surgical meshes incite minimal inflammation and tissue reaction and gradually encapsulated by fibrous connective tissues. They are not hydrolyzed or absorbed in the body. It also helps in minimizing wound sinus formation and suture extrusion.
Meshes are sterilized by ethylene oxide after ultrasonic cleaning.
It should not be used in patients having a known history of hypersensitivity to polypropylene. During handling, damage should be avoided.
Eg. Dolphin mesh by Futura Surgicare (Dolphin sutures)
PM type mesh – thinner, smoother, and more flexible
PS type – Strong, thicker and normal flexibility
Prolene is nonabsorbable suture material used for general soft tissue approximating and/or ligation, ophthalmic procedures, orthopaedic surgeries, neurological procedures, gynaecological procedures, dental surgeries, herniorrhaphy, on the skin, cardiovascular surgeries, peripheral vascular surgeries, plastic and microsurgeries.
Depends on the location. Sutures in internal organs (graft anastmoses or tissue to tissue anamstmoses) don’t need to be removed while it has to be removed if used for approximation on the skin. h low skin tension continues to be evaluated.
It does not get dissolve. Prolene suture retains tensile strength for indefinite time in vivo.
No. Prolene suture doesn’t get dissolved in the tissue.
PROLENE Sutures are composed of an isotactic crystalline steroisomer of polypropylene, a synthetic linear polyolefin. They are dyed blue to enhance the visibility.
No. But both are synthetic non-absorbable monofilament sutures.