Which of the following absorbable sutures causes the maximum tissue reaction?

AIIMS Nagpur NO- 2020

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Nagpur NO- 2020

Explanation

Catgut is a natural absorbable suture derived from the submucosa of sheep intestine or serosa of beef intestine.
Being a foreign protein, it is degraded by the body's proteolytic enzymes, which triggers a significant inflammatory response.
This enzymatic degradation process is much more reactive compared to the hydrolysis process that breaks down synthetic absorbable sutures.
Due to this intense inflammatory reaction, catgut is considered the absorbable suture with the highest tissue reactivity.

Option A: Polygalactin (e.g., Vicryl) is a synthetic absorbable suture. It degrades by hydrolysis, a process that causes only a minimal inflammatory reaction.
Option C: Polypropylene (e.g., Prolene) is a synthetic, but non-absorbable, suture. It is known for being one of the most inert suture materials, causing minimal tissue reaction.
Option D: Polydioxanone (e.g., PDS) is a synthetic absorbable suture. Like polygalactin, it degrades via hydrolysis and is associated with a low level of tissue reaction.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Tissue reactivity of absorbable suture materials as background academic context rather than a clinical decision trigger.
The choice of suture material is critical for wound healing. High tissue reactivity, as seen with catgut, can lead to increased inflammation, delayed healing, more prominent scar formation, and a higher risk of infection.
Low-reactivity synthetic sutures are generally preferred, especially for internal tissues, to minimize the inflammatory response and promote cleaner healing.
Catgut is now used less frequently in many countries due to its high reactivity and the availability of superior synthetic alternatives. However, it may still be used in specific situations, such as ligating small vessels or in tissues that heal quickly.

How to Approach the Question

First, identify the key terms in the question: 'absorbable sutures' and 'maximum tissue reaction'.
Next, classify the given options based on their material origin (natural vs. synthetic) and whether they are absorbable or non-absorbable.
Recall the general principle that natural, biologic materials (like catgut) tend to provoke a stronger inflammatory response from the body than synthetic materials.
Differentiate the mechanisms of absorption. Natural sutures like catgut are broken down by enzymes (proteolysis), which is an active inflammatory process. Synthetic absorbable sutures are broken down by hydrolysis, which is a more passive and less inflammatory chemical reaction.
Evaluate each option: Polygalactin and Polydioxanone are synthetic and absorb via hydrolysis (low reaction). Polypropylene is non-absorbable and very inert (low reaction). Catgut is natural and absorbs via enzymatic action (high reaction).
Based on this comparison, conclude that catgut causes the maximum tissue reaction.

Concept Tested & Keywords

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E6 Gynecology Williams p. 430-440