Catgut suturesA Timeless Classic or A Thing Of The Past? NO-More Catgut PRESENTED BY ASMA -UL -HUSNA M.PHIL ,DU PRODUCTS SPECIALIST Nazmul Huda Aesculap suture Divisional In charge BD

CATGUT ProductionSheep intestine (Submucosa)

Cut into ribbons

Washed and bleached (remove impurities)

(Chroming process: washed, buffered, dyed)

Ribbons spun together

Drying, polishing Twisted

INTRODUCTION

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1990 the number of animals affected by BSE had been increasing in Europe

1996 France banned the use of Catgut in its hospitals

2000-2002 Austria, Japan, Germany, UK, Jordan and the Kuwait banned Catgut. Jordan was the first Middle East country to ban Catgut,

EU banned catgut in all of Europe. This includes distribution and manufacture.

CATGUT: REASONS WHY NOT

1. Unpredictible behaviour. Breakdown of catgut is accelerated in infected tissue . in addition, the loss of strength of the catgut suture can even vary from site to site in the human body.

2. Inflamatory response. Catgut contains collagen, as biologically active molecules not belonging to the human body. The human body strives to remove all proteins and fragments of proteins that could have A foreign biological function as this could harm the human metabolism, therefore causing inflammation

3. Disease transmission. Due to the organic bovine origin of catgut, the issue of safety can be raised in the form of (tses). Put patients at risk of certain diseases that catgut can.

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SOURCE: 1. http://ec.europa.eu/health/scientific_committees/emerging/opinions/scmpmd/scmp_out05_en.htm2. Kruger, T.F, et al. Clinical Gynaecology. Third Edition, 2007 Juta & Co. Ltd. Page 554 3. Wallace WR, Maxwell GR, Cavalaris CJ. Comparison of polyglycolic-polyactic acid suture to black silk, chromic and plain Catgut in human oral tissues. J Oral Surg 1970; 28; 739-746 4. Gilstrap, L, Cunningham, F, VanDorsten, J. Operative Obstetrics. Second Edition 2002, The McGraw-Hill Companies, Inc. Page 57..

5 Main Reasons Why Not To Use Catgut Any More:

CATGUT: REASONS WHY NOT

4. RECOMMENDATIONS.

– Biosecurity Australia, an agency within the Australian Department of Agriculture Fisheries and Forestry, identifies Catgut as a “high TSE risk product”

– Catgut was confirmed a poor choice for use in contaminated wounds by the Scientific Committee on Medicinal Products and Medical Devices (SCMPMD)6

5. IT IS NOT NEEDED!!. Modern absorbable sutures have improved tensile strength and prolonged knot-retaining capabilities compared to Catgut. In fact, SCMPMD report concluded that comparable synthetic absorbable sutures, which can be substituted for Catgut sutures, have been found to provide equal, or increased clinical performance than Catgut sutures

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SOURCE: 5. Department of Agriculture Fisheries and Forestry Australia, ‘Measures to address additional TSE concerns with veterinary vaccines and other high risk biologicals’, November 2001 6. http://ec.europa.eu/health/scientific_committees/emerging/opinions/scmpmd/scmp_out05_en.htm

What are TSEs and BSE?• Transmissible spongiform encephalopathy’s (tses) are a family

of diseases occurring in man and animals and are characterized by a degeneration of brain tissue giving a sponge-like appearance leading to death.

• The commonly accepted cause of the tse disease is a transmissible agent called prion (prpres), which is an abnormal form of a protein.

• The family includes diseases such as --creutzfeldt jakob disease (cjd) and kuru in humans, bovine spongiform encephalopathy (bse) in cattle, scrape in small ruminants (sheep and goats), chronic wasting disease (cwd) in cervids and transmissible mink encephalopathy (tme) in minks

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Can any alternative of catgut chromic/plain ? Yes !

Modern Synthetic Absorbable Monofilaments suture

Monosyn & Monosyn quickCan be a perfect alternative of catgut chromic/plan

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Catgut® plain is an absorbable natural suture, made of collagen catgut® plain is a twisted suture with a micro polish treatment that converts the surface into monofilament

• Catgut ® is treated with glycerol containing solution. The suture material retains its original pliability and softness on removal from the packaging

Monosyn and Monosyn Quick® are an excellent absorbable synthetic monofilament suture made of Glyconate (Glyconate, a terpolymer made of: 72 % glycolide,14 % TM C,14 % ε-caprolactone )

• Exclusively engineered by B. Braun for the suturing of soft tissues

• Monosyn and Monosyn Quick remain its original pliability and softness before depredation in addition elastic properties ensure knot security

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CATGUT V/s MONOSYN & MONOSYN QUICK