DE2638831A1 - SURGICAL SUTURE MATERIALS CONTAINING NEOMYCINE FATTY ACID SALT - Google Patents

Description

DR. J OACH IMSTEFFENS

DIPLOMA CHEMIST AND PATENT ADVOCATE -...,. _Ί -sol

D-8032 LOCHHAM MÖNCHEN MOZARTSTRASSE 24 PHONE. (089) 87 2SSl TELEXi (OS) 29830 lUff d

YOUR SIGN·

MY CHARACTER i Kurtz— 34

August 27, 1976

Sutures, Inc.
Main Street, Coventry, Connecticut / USA

Surgical sutures containing neomycin fatty acid salt

The invention relates to colored or uncolored containing a substantially water-insoluble biocidal salt Sutures with improved flexibility or suppleness and buttonability. In particular, the invention relates to multi-thread sutures in which the suture body is continuously coated with a neomycin fatty acid salt and - according to a preferred embodiment - is provided with a combination of a neomycin fatty acid salt and wax.

All surgical sutures must be easy to handle and knot by the surgeon and on the other hand the effect on the patient's body must be taken into account. One can assume that currently most common knotting method, i.e. the Knotfeohnik used for surgical silk, are preferred by surgeons would. It would be ideal for the surgeon if every suture material had the same knot properties as surgical silk

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could be awarded.

With all surgical sutures, the effect of the material on infection must also be considered. It has been found that multi-thread sutures tend to promote infection more than single-thread sutures; see. eg "Surgical Sutures and Infection, A biomaterial evaluation" of RP Edlich, PH Panek, GT Rodeheaver, LD Kurtz and MT Edgerton, Journal of Biomedical Materials Research, Vol. 8 (197 ^1L), pages 115 to 126, and "Potentiation of Infection by Suture Closure of Dead Space" by D. DeIIoIl, G. Rodeheaver, MT Edgerton and RP Dudley, American Journal of Surgery, Vol. 127 (197 ¹ I), pages 716 to 720. All single-thread and multi-thread sutures however, they are potential sources of infection.

Viewed as a whole, it is beneficial if the suture material has the "handle" and the ease of use of surgical Standard sutures made of silk and have no infection-promoting effect.

In an attempt to solve these problems, a Dacron suture was used coated with polytetrafluoroethylene particles and impregnated (see US Patents 3,322,125 and 3,390,681). One the functions of the particles made of polytetrafluoroethylene (Teflon) consisted of the knofbarkeit of the Dacron surface in about alter those of standard surgical silk sutures. The other function was to fill the spaces in between and thus in a transformation of the multi-thread Dacron sutures into a "functional single thread". Such a "functional monofilament" would have a lower infection-promoting factor Effect as the multi-thread suture material, but would not completely solve the problem, as all single threads are favor the infection.

It has therefore been proposed to impregnate sutures with various water-insoluble biocidal salts in order to give them a

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sustained over long periods of time due to the slow release to impart bactericidal effect; See US Pat. No. 3,896,813, which are long-term germicidal in their manufacture However, sutures are often found to have the "feel" and buttonability of conventional surgical silk is not achieved.

Another, in the production of a salt with long-term Sutures containing biocidal action frequently encountered problem is that the sutures are colored to be visible to the surgeon. In the Impregnation of colored sutures with solutions of the however, the desired biocidal salt has encountered considerable difficulties due to loss of color. A corresponding Loss of biocidal salt also occurs with the reverse Order (i.e. if the coloring after impregnation takes place with the biocidal salt).

It is therefore an object of the invention to produce in a single operation (i.e. without the aforementioned addition of Polytetrafluoroethylene is required) colored and To provide undyed, multi-thread surgical sutures which have an improved "feel" (softness and flexibility) and improved buttonability as well have long-term biocidal properties.

Another object of the invention is to create a multi-thread surgical suture material, which in addition to the desired "grip" and the desired knot-strength long-term (therapeutic and prophylactic) biocidal action against both gram-negative and gram-positive Has bacteria.

Another aim of the invention is to create a colored, biocidal.

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the substance is characterized by a high degree of uniformity over the entire body of the suture material.

These and other objects of the invention are achieved in that one is the body or the structure of a multifilament, surgical Sutures uniformly throughout with a neomycin salt of at least one fatty acid with about 12 to 18 carbon atoms provides. Optionally, the surgical suture of the invention can be made by having the At the same time the suture material body is colored and impregnated with the neomycin salt suitable according to the invention.

An important feature of the invention is that the invention used neomycin salts despite their pronounced water insolubility a surprising therapeutic and prophylactic effectiveness against various gram-positive and gram-negative bacteria such as Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa or Proteus mirabilis. The invention thus provides a multi-filament suture material which has the ability possesses to "clean" contaminated tissue of the infection within a short time (therapeutic effect) and afterwards continued to provide a permanent supply of a water-insoluble antibacterial salt which, due to the slow release of the relatively insoluble antibiotic over a long period of time ensures a broad spectrum of activity (prophylactic effect). All of these advantages are achieved without compromising the flexibility and knotability of the suture is so affected that softening and knotting aids (such as polytetrafluoroethylene particles) are required.

Another important feature of the invention is based on the surprising finding that a mixture of the invention used neomycin salts and the wax used according to the invention, which evenly in the entire suture body is incorporated, the advantageous softness, flexibility

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ability and knofworthiness; of standard surgical silk. These beneficial properties become the surgical sutures by other water-soluble antibiotic salts (including neomycin salts) in connection with the wax not awarded. It has also been found that the neomyein fatty acid salt has its brittleness due to the action of the wax which loses its resistance to the formation of flakes or flakes, which affects the dosage harmful.

The reason why the neomycin fatty acid salts used according to the invention bringing about the mentioned advantages in contrast to other antibiotic salts is not fully understood. It is believed that several factors are responsible for this; these mainly consist of

1) the characteristic slippery or slippery nature the salts,

2) the ability of the salts to become adherent fillers within of the multi-threaded suture strand and to solidify the suture strand, whereby the tendency of the Salt is increased to be retained both within the cavities and on the suture body, and

3 ') the relative water insolubility of the salts, which are not go ahead. their ability to remain within the suture contributes, but also enables the gradual release of the neomycin and thereby for a long-term provides a biocidal effect.

While the impregnation according to the invention with a neomycin -Fatty acid salt is acceptable to the multifilament sutures Softness, pliability and knollbarkeit as well as the beneficial ones On the other hand, when it imparts properties to a monofilament, it tends to make the sutures too slippery do. Therefore, the knot restraint or retention, i.e. the resistance of the knot to the slip

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fen, in one treated with the neomycin fatty acid salts Sutures not as good as standard surgical silk sutures. According to a further embodiment of the invention, the lubricity of neomycin fatty acid salts is improved treated sutures eliminated or at least substantially reduced and the tied sutures achieves the same slip resistance as a standard silk seam material again, by combining the surgical sutures of the invention with a combination of those useful in the invention Neomycin fatty acid salt and a wax. The neomycin salt and wax can be incorporated at the same time; however, the two components are preferably added in separate stages, namely the wax after the biocide. In In each case, a surgical suture material is obtained which, when knotted, has essentially the same knot looseness like conventional surgical silk. This is in contrast, for example, to those containing the neomycin salt alone surgical sutures, -which one versus conventional surgical silk show increased knot looseness. -.

The term "neomycin" in the present application refers to the antibiotic described in more detail in Waksman, Neomycin, The Williams and Wilkins, Co., Baltimore, Md. (1958). This designation includes the separate and closely related antibiotics known as "Neomycin B" and "Neomycin C" and mixtures thereof. The neomycin salts used according to the invention can be prepared by reacting a suitable neomycin reaction component such as neomycin sulfate or neomycin hydrochloride with a fatty acid reaction component (in the form of the free fatty acid or an alkali salt thereof). Specific examples of suitable fatty acids are palmitic acid, stearic acid, oleic acid, lauric acid, myristic acid, palmitoleic acid, arachidic acid and mixtures thereof.

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The neomycin fatty acid salts can be prepared simply by mixing a solution of the fatty acid reaction component in an alkanol solvent with an aqueous solution of the neomycin. The reaction can also be carried out in aqueous solutions of the alkali metal salts of fatty acids. Theoretically, complete conversion generally requires 6 moles of the fatty acid (s) per mole of neomycin. In order to achieve optimum yields, however, it is preferred to use an excess of fatty acid. A more detailed explanation of the methods for preparing the neomycin salts used according to the invention can be found in US Pat. No. 3,013,007.

Specific examples of neomyein salts which can be used in the present invention higher fatty acids are neomycin palmitate, neomycin stearate, neomycin laurate, neomycin myristate, the neomycin salt of coconut oil fatty acids and the neomycin salt of tallow fatty acids. The neomycin salt preferred according to the invention is neomycin palmitate.

The neomycin fatty acid salt can thereby be used on the multifilament Sutures are applied by simply treating the suture substrate with a solution of the water-insoluble neomycin salt in a solvent (e.g. an organic solvent) that dissolves the neomycin, the suture but does not dissolve itself, brings it into contact. The neomycin salt solution covers the suture material and penetrates it Spaces a. The solvent can then e.g. Evaporation or extraction can be removed, leaving the salt remains as a coating on the entire multi-filament strand as well as incorporated within the entire strand body. This method of coating application and impregnation a solution also has the advantage that it is in the suture contained neomycin can be precisely determined. The preferred method of impregnation is to place the suture under low tension and slow enough to ensure saturation, through the neomycin salt solution.

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guided.

An alternative method to the application of the neomycin fatty acid salt on or in the suture is that the salt is generated in situ by first using the suture a solution of the fatty acid reactant and then treated with a solution of the neomycin reactant. In each of the above-mentioned impregnation methods, the solutions used can be given a swelling agent, which the Impregnation in the suture reinforced, incorporated. Water or an organic solvent can be used as the swelling agent to serve. The solutions can be heated as needed to promote impregnation, provided that the neomycin fatty acid salts are not significantly affected by the heat.

The concentration of neomycin fatty acid salt in the surgical Sutures depend on the intended purpose and the particular microorganism against which a therapeutic and prophylactic protection is sought. However, the neomycin fatty acid salt should always be in effective concentrations are present. These concentrations should be sufficient to reduce the number of bacteria that may be present in a wound is reduced as much as possible, preferably to the value zero, so that the area of infection is complete is "cleaned". A suture with such a concentration of the neomycin fatty acid salt does not have just one excellent therapeutic effect against infections, but also prevents an existing infection from being promoted becomes, as is usually the case with the presence of a suture. This effect is usually found with Use a concentration of the neomycin fatty acid salt (based on the suture material) of at least about 3 »28 mg / m (3 mg / yd) up to 32.8l mg / m (30 mg / yd) or more. The preferred neomycin salt concentrations are in the range from about 7.66 to 12.03 mg / m (7 to 11 mg / yd).

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If the surgical sutures are provided with a combination of the neomycin fatty acid salt and a wax, the concentration of the wax in the neomycin salt-containing suture material should be the same as or less than that in standard surgical silk sutures of the corresponding fineness (size) and be sufficient for the knot "bark ext is approximately achieved by conventional surgical silk. In addition, the wax removes the brittleness which is imparted to the suture material by the neomycin salt. Conventional silk suture materials contain - depending on their fineness - 4 to 5 % wax. The desired wax concentration in the sutures according to the invention leaves can be achieved by immersing the suture material containing the neomycin fatty acid salt for about 0.07 to 0.1 seconds in a 15% (w / v) solution of the wax at a speed of 76.2 up to 106.7 cm / sec. (30 to 42 inches / sec) is passed through the wax solution. The wax solutions are prepared by dissolving the wax in a suitable solvent (e.g. an organic solvent). The preferred organic solvents for the wax are alkanols, in particular n-propanol. During the wax treatment, the wax solution is expediently kept at the lowest possible temperature, which is just sufficient to keep the wax in solution. Furthermore, the wax treatment takes place in the shortest possible time, in which the suture material is provided with the desired wax concentration. The reason for the use of the low temperature and the rapid passage of the suture material through the wax solution is that the risk of the neomycin fatty acid salt leaching out of the suture material is to be eliminated. The solvent for the wax usually also dissolves the neomycin fatty acid salt. The particular temperature at which the wax solution is maintained, of course, depends on the particular wax or wax mixture, but is usually in the range of about 60 to 82.2 ° C (about I ¹ IO to 180 ⁰ F).

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Examples of waxes which can be used according to the invention are animal ones Waxes such as whale wax or wool wax (Degras), insect waxes such as beeswax, vegetable waxes such as carnauba wax, Petroleum waxes, such as paraffin wax, as well as microcrystalline ones Waxes and synthetic waxes, such as Carbowax (polyethylene glycols or their ethers).

After the wax treatment, this is done with the neomycin fatty acid salt and the wax impregnated suture material is dried; in the case of synthetic materials (like Dacron) then it is ready for sterilization and packaging. In the case of silk, it is impregnated with the neomycin fatty acid salt and wax Sutures are then applied to a silk hot-stretching machine using the conventional method for silk desired fineness hot drawn.

The multifilament sutures impregnated according to the invention have a conventional structure and are made of known materials, i.e. natural or synthetic sutures, such as silk or polyethylene terephthalate. Before the application of the neomycin salt and wax according to the invention Preferably, the sutures are dyed by any conventional staining technique. Preferred for coloring the known printing dyeing methods, in which the dye is wrapped around perforated, hollow coloring elements is pressed. The perforated coloring elements are generally in the form of a hollow tube or cone and can consist of metals such as aluminum or corrosion-resistant steel, or of plastics.

Known ones are suitable for the suture materials according to the invention Dyes. The following recognized FDA dyes are suitable for the specified materials:

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Silk dacron

(Polyethylene terephthalate)

Nylon (polyamide) cotton polypropylene

Logwood

- D&C Green # 6

- Logwood and D.C. Green # 5

- D.C. Green # 9 [Phthalocyaninato (2-D] copper.

To get dyed, multi-thread sutures with a uniform To achieve neomycin salt, wax and dye concentration, a dye must be chosen which has a relatively low solubility in the solvents used for the neomycin salt and V / ax to be incorporated. On the other hand, one chooses for the impregnating agent is a solvent which does not have a pronounced dissolving power for the dye used owns. The coloring of the seam materials can be done according to the invention also at the same time as the application of the neomycin salt and wax made; in this way of working becomes natural any leaching of the impregnating agent avoided.

The following examples are intended to explain the invention in more detail without, however, restricting it.

B e is ρ i e 1 1

228.6 m (250 yd) of surgical Seidenriahtmaterialien which were stained in a conventional manner with Logwoöd dye and treated with aluminum acetate, are measured and 3 hrs. At 93.3 ° C (200 ⁰ F) in the oven.

A 15 # (w / v) solution of neomycin palmitate in n-propanol is also prepared by mixing the solvent and the salt and bringing the mixture to a temperature of 37.8 to 43.3 ° C (100 to HO ⁰ F) heated to bring the neomycin palmitate into solution. The solution is then put into a long

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gen, narrow, 2.5'I cm χ 2.5 ^ cm χ 2, Ml m (1 in. χ 1 in. χ 8 ft) measuring trough cast. The sutures are then slowly pulled through the solution under low tension (ie, under a load of 0 to 20 grams) to ensure maximum uptake. While the solution is in the trough, its temperature is maintained at about 32.2 ⁰ C (about 90 ⁰ P). The dwell time in the 2. Hk m (8 ft) long trough is about 50 to 72 seconds for the suture material with this fineness.

After the treatment with the neomycin palmitate, the suture material passed directly from the solution through a heated vertical tower. The suture rises 5, ^ 9 m (1δ ft) up before it touches the first guide element. Then it is led down to a take-up roll, which so runs slowly as possible so that a sufficient drying time is guaranteed. The impregnated silk stitching material is then on a silk hot stretching machine according to the usual method for silk to the desired fineness (2/0) hot drawn.

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250 yd (228.6 m) of braided (2/0) Dacron surgical sutures which have been dyed, hot drawn and plasticized by the method described in U.S. Patent 3,839,52 ^{J I are measured and 3 hours at 93} , 3 C (200 F) oven dried. A 40% (w / v) solution of neomycin palmitate powder in n-propanol is also prepared. A suture is impregnated with the neomycin palmitate according to the general method described in Example 1; however, the braided Dacron suture material impregnated with the neomycin palmitate is not hot-drawn after the impregnation, as is the case with silk sutures.

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Example 3

It is made with both neomycin palmitate and wax impregnated dacron and silk seam materials as follows:

The sutures are first treated with neomycin palmitate using the general methods of Examples 1 and 2. To After drying, the treated sutures are waxed in as follows:

A mixture of beeswax and paraffin wax is made in butyl acetate solved. 12.52 liters of butyl acetate are used per kg of wax mixture (625 g beeswax and 375 g paraffin wax). The suture material impregnated with the neomycin palmitate is passed through the Wax solution passed through using a 7.62 cm (3 in) cycle. The immersion time in the wax solution is about 0.7 to 0.1 second.

The silk sutures treated in the manner described above with neomycin palmitate and wax are then hot-drawn on the side hot-stretching machine according to the usual method for silk to the desired fineness. It is not necessary, the Dacron sutures after wax application hot stretching, as it is stretched to the desired fineness before the neomycin palmitate is applied became.

Table I illustrates the silk and dacron sutures thus obtained and those in the treatments applied special conditions:

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TABLE I.

Treatment with neomycin and wax

SILK

Fineness of neomycin residence time ^ m wax mixture (size) palmitate, 2.44 m trough, kg (lbs) % sec.

50

15th

15th
5.5
3.5

80 to 68 80 to 50 72 to 50 92 to 40 92 to HO

0.45 0.68 0.68

(2)

(2)

(D

(1.5)

(1.5)

Degree of hot stretching after the wax treatment, '/,

3 9

Ik 14 15

DACRON

fineness Neomycin 50 Dwell time ^ m m-trough, Wax mixture **, (2) degree of (Size) palmitate, 60 2.44 kg (lbs) (2) Heat seal % 60 Sec. (1.5) stretching 40 (1.5) after Wax to 68 action, % 7-0 80 to 59 0 _s 91 0 4-0 90 until 50 0.91 0 2-0 90 up to 40 O _p 68 O 2 77 O _p 68 0

The material is used to achieve maximum neomycin palmitate absorption, kept in the trough as long as possible. The residence time in the solution is at least 40 seconds, but can vary - depending on the size of the take-up roll - also stretch for up to 90 seconds.

(10 oz.) _s 5 kg (1 Ib) .Wachsmischung from 283.5 S beeswax and 17Q _S 1 g (6 oz.) paraffin wax, in 5 »l of 68. (6 quarts) of butyl acetate.

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B e i s ρ i e 1 ¹ I.

According to the example; 3 manufactured. Silk and Dacron sutures (2/0) containing neomycin and wax are compared with untreated sutures on tissue from mice contaminated with Staphylococcus aureus. With the exception of the fineness of the suture material, the test method described in "Physical and Chemical Configuration of Sutures in the" Development. """Of Surgical Infection", RF Edlich, -PH Panek, GT Rodeheaver, L> D. Kurtz and MT Edgerton, Annals of Surgery, Vol. 177 (1973) ₃ pp. 679-688.

On the fourth day after the operation, the sutures are removed and examines the needle line for the presence of an infection, by excising a block of infected tissue and quantitatively analyzing it for viable bacteria. The test results can be seen from Table II.

TABLE II viable
bacteria
after 4 days Sutures
"■.. - ■. - *
Inocolum
(Number of bak
teries) 10 ² 2/0 silk. ΙΟ ³ ΙΟ ⁴ 2/0 silk 10 ⁵ 10 ⁶ 2/0 silk 10 ⁶ O none (needle line). / 10 ⁵ 10 ³ II If 10 ⁶ O 2/0 silk treated with
Neomycin salt / wax 1O ⁶ ' ⁵ 10 ⁵ ^ j 2/0 Dacron 10 ⁵ . ΙΟ ^{6 σ} 2/0 Dacron
CC * t - ao « O W -
oo none (needle line) ίο = ΙΟ ³ «T"" ¹ - -. - 10 ⁶ O _o 2/0 Dacron, treated mxt
C _n neomycin salt / wax
CD. ; 6 R

Staphylococcus aitvei * 5

i. O · - OOI

The above data confirm that the presence of a silk or dacron suture promotes the growth of bacteria (if any) in the wound. The data also show that the neomycin palmitate treated sutures of the present invention reduce the number of viable bacteria to zero within ½ days. This clearly shows the therapeutic effect of the biocidal suture materials according to the invention.

The sutures of the invention give the same excellent results Results against the bacteria Proteus mirabilis, E, coli and Pseudomonas aeruginosa. In the latter bacteria a neomycin palmitate concentration of about 3383 mg / m is sufficient (3> 5 mg / yd) however, not off «To the desired therapeutic To achieve an effect, one must increase the concentration of the neomycin palmitate to 7 * 66 to 8.75 mg / m (7-8 mg / yd).

The following example illustrates the improved knot retention of surgical sutures which Contain both the neomycin fatty acid salt and wax.

example

Conventional surgical silk (2/0) (with a wax content of mg / m) is mixed with neomycin palmitate according to Example 3 treated that a surgical suture material with a neomycin content of 3 »83 mg / m (3.5 mg / yd) is obtained. Furthermore, according to Example 3, a silk suture material with a content of 3 a83 mg / m palmitate and wax is produced (the wax consists of beeswax and paraffin wax in a weight ratio of 10: 6) 0 in the sutures produced in this way several square knots are tied, which one each from three or four superimposed loops or "throws" ("throws") whose "grips" or "Öaen" (ears) the have lengths as shown in Table III. Each knot is then tested by putting the suture on each side

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of the knot and tighten to see if the knot "slips". One determines the ratio of the number of hatched Nodes to the total number of nodes; Table III shows the results.

Dacron sutures are also treated according to Example 3, with sutures containing 4.05 mg / m (3j7 mg / yd) neomycin palmitate and dacron sutures with a content of 4.05 mg / m (3.7 mg / yd) neomycin palmitate and Wax (beeswax and paraffin in a weight ratio of 10: 6) can be obtained. The Dacron sutures are then also tested for knot retention. The results are also shown in Table III.

3 3 3 3

TABLE III

Knot retention of treated silk sutures

Over-grip throws length

0 _s 2

0.3 0.4 0.6

Number of knots hatched / total number of knots

surgical neomycin pal- neomycin palmi silk mitat / silk tat / wax / silk

1: 5 0: 5 0: 5 0: 5

2: 5
2: 5
2: 5
0: 5

1: 5 1: 5 0: 5 0: 5

throws

3 3 4 4 4 4

Knot retention of treated dacron sutures

Handle length

0.3 0.4 0.1 0.2

0 _s 3 0.4

Number of knots hatched / total number of knots

surgical dacron

0: 5 0: 5 0: 5 0: 5 0: 5 0: 5

Neomycin palmitate / dacron tat / wax / dacron

5: 5 5: 5 5: 5 5: 5 1: 5 0: 5

4: 5

2: 5

2: 5

0:

0:

; 5: 5

0: 5

The above values show that the addition of Neomycx palmitate has a tendency to make the sutures slippery compared to conventional silk and dacron sutures, thereby reducing the Knot retention is compromised. The values show that this tendency for the knot to slip or slip at sutures containing both neomycin palmitate and wax are greatly reduced.

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Claims (11)

P ATENT TO S P R Ü C HE , 1, Soft, pliable, multi-thread surgical suture material with a knotability of surgical
Standard silk approaching knot "bark ext" as well as therapeutic and prophylactic effectiveness
bacterial infections, consisting of a multi-thread surgical suture, which is applied evenly and within the entire suture body
incorporated effective amount of a neomycin salt of at least one fatty acid having 12 to 18 carbon atoms
having. 2. Suture material according to claim 1, characterized in that the neomycin fatty acid salt is neomycin palmitate. 3. "suture according to claim 2, characterized in that the neomycin palmitate in a concentration of at least about 3 »28 mg / m of the suture material (at least about 3 mg / yd suture material) is present. 4. suture material according to claim 3, characterized in that the neomycin palmitate in a concentration of at least about 7.66 mg / m of suture (at least about 7 mg / yd suture material) is present. 5. suture material according to claim 1, characterized in that the basic material consists of silk. 6. suture material according to claim 1, characterized in that the base material consists of polyethylene terephthalate. 70 9842/0 59 7 · suture material according to claim 1, characterized in that within the entire. Wax evenly in the body of the suture containing the neomycin fatty acid salt
a concentration is distributed which is equal to or less than the concentration in conventional surgical silk of corresponding fineness and is sufficient for the
Knotability of conventional surgical silk is almost reached. 8. suture material according to claim 7, characterized in that the wax is a mixture of beeswax and paraffin wax
represents. 9. suture material according to claim 7, characterized in that the neomycin fatty acid salt is neomycin palmitate. 10. suture material according to claim 7, characterized in that the basic material consists of silk. 11. Suture material according to claim 7> characterized in that the base material consists of polyethylene terephthalate. 109842/0597