Wound Closure Materials And Doreign Body Implants In General Surgery Practice:

Wesam Ibeahem Abdelsalam Homouda

s........, •.. eo•.••.••DermatoIogie wounds can heal by 8eOOIIdary intention,. or 1IJey can beclosed by a variety of methods. Although the skill and teclmique of thesurgeon are important. so is the d1oi£e of wound closure m.h•••. The:purpose of these materials is to maintain wound closure until a wound isstrong enotJ8b to withstaDd daily tensile fom:s and to enha..re woundhealing when the wound is most wlnerable.Several methods of wound closure are available to be ubIized ftomsutures to laser assisted wound closure passing with staples, strips, fibrinsealant. and tissue glue.Sutures are the most widely used method for wound closure soundersta’ding the various characteristies of available suture materials isimportant to make an educated selection. No one suture possesses alldesirable dwaeteJistics. The: optimal suture should be easy to lumdle andhave high tensile strength and knot security. Any tissue reaction should beminimal, and the material should resist infedion and have good eIastieityand plasticity to accommodate wound swelling. A low cost is preferred.Although some of the newer materials available have many of theseproperties, no one material is ideal and comparison must be made.Sutures can be divided into natural or synthetic, absorbable and nonabsorbable,and either monofilament or multifilament. although the naturalsutures have been used largely for most surgical situations, the recentlysynthetic sutures may be desirable for, among other reasons, reducing thechronic tissue reactivity to foreign organic material.The decision of choosing between absorbable and non absorbable is128-----------------whether the need ror sutures is temporary or permanent mechanicalsupport.Multifilament em be twisted or braided. Monofilaments areadvantageous because multiple strands of the muItitiIamat piuvideenvironment fi>r infection, multifilament :Sutures particularly in theirbraided torm. tend to be DlOIe whJembIe to shearing foa:es and thus DlOIesusceptible to breakage Monofilamentsare liable to be weakened by gripof the furceps and other instnu.le.ots.Other methodsof wound closure are not :SO widely used as suture eitherbecause their oo8tOl’their limitedavailability.Synthetic implants are an invaluable tool for the facial plasticsurgeon. Fixa1ion of fiadure:s. soft tissue and bony JeCODStnIdifm,. andcosmetic augmentation may all be addressed with a wide variety ofsyntheticimpJauts.Metals was the first materials to be used for implant fabrication, goldand silver have had a place in soft tissue augmentation sint:e the sixteenthcentury. Paraffin and ivory gained popularity in the early 19OOs;however,tissue reaction, granulomas. lack of immobilization, and teclmieaIdifficultieseventually dismissed their useWith industrial advance plastic polymers were used for soft tissueaugmentation. Initially, methylmethacrylate, polypropylene, andpolyethylene were used extensively.but the Jack of maHeabilit¥and theneed tor prefabrication led to the development of softer alloplasts. In the19508, silicone. Dacron, and nylon gained popularity because of theirbiocompatibility, ease of fabrication, and propertiesthat make it possible129-~._-._---to individnaJin: ~ implant to the patient’s requirements.--- ••• ------ SU11f11U119 tIIUl e..Ju.,.,.All these .• are used to produce a large variety of lmpIImtablcdevices .•• to restore body shape or fimction such as Mesh implant,Tissue • ’. Breast implant. peaiIe implant,. amd Dermal fiDeJs..130-- -- - --- -----