What are the uses of Ethibond (non‑absorbable braided polyester suture)?

Ethibond Uses in Surgery

Ethibond (braided polyester suture) is a non-absorbable suture material primarily used in situations requiring permanent or long-term tissue support, including strabismus surgery for thyroid eye disease, tendon repairs, diaphragmatic hernia repair, and other orthopedic and general surgical applications where sustained tensile strength is critical.

Ophthalmic Surgery Applications

Strabismus Surgery in Thyroid Eye Disease

• Ethibond is specifically recommended for large inferior rectus muscle recessions in thyroid eye disease to reduce the risk of postoperative drift and overcorrection 1
• The permanent polyester suture helps minimize unanticipated muscle drift when combined with wider spreading of the muscle to prevent sagging of the insertion over time 1
• While surgeons generally prefer absorbable sutures (6-0 polyglactin) for routine muscle isolation and reattachment, some favor non-absorbable sutures like Ethibond for large inferior rectus recessions because they may reduce the risk of postoperative overcorrection 1

Clinical Pitfall: Recession of the inferior rectus muscle is frequently complicated by consecutive hypertropia due to suboptimal contact of the recessed muscle with the globe, making permanent suture selection particularly important in these cases 1

Orthopedic and Tendon Surgery

Tendon Repair Applications

• Ethibond demonstrates superior tensile strength (100.3 ± 19.1 N) compared to newer absorbable materials in tendon repair, making it the gold standard for load-bearing core sutures 2
• In Adelaide 4-strand core suture technique for tendon repair, Ethibond achieved tensile strength of 83.6 ± 11.2 N, while 6-strand Savage suture reached 147.4 ± 22.7 N 2
• Ethibond maintains stable material properties over 2 months of physiological incubation, unlike absorbable sutures that degrade 3

Comparative Strength Data

• While newer high-strength sutures (FiberWire, MaxBraid, Orthocord) outperform Ethibond in single load-to-failure testing, Ethibond remains a reliable standard with proven long-term stability 4
• Ethibond demonstrates superior knot security and ultimate tensile strength compared to absorbable alternatives like caprolactone/glycolide (Panacryl), with significantly greater force required for both 3-mm knot slippage (p < 0.0001) and catastrophic failure (p = 0.0284) 5

General Surgical Applications

Diaphragmatic Hernia Repair

• For traumatic diaphragmatic hernia repair, surgeons prefer interrupted non-absorbable 2-0 or 1-0 monofilament or braided sutures (including braided polyester like Ethibond) in two layers 1
• Primary repair with non-absorbable sutures should always be attempted when possible, using interrupted mattress suture technique 1
• For defects larger than 3 cm, mesh reinforcement is recommended in addition to suture repair to reduce the 42% recurrence rate associated with primary repair alone 1

Material Properties and Characteristics

Physical Properties

• Ethibond is a braided polyester fiber coated with polybutylate (polytetramethylene adipate), which provides improved handling properties, reduced tissue drag, and minimal tissue reactivity 6
• The polybutylate coating distinguishes Ethibond from uncoated polyester sutures, enhancing surgical handling while maintaining the strength of polyester fiber 6

Stability Over Time

• Ethibond shows stable material properties during 2 months of physiological incubation (37°C, pH 7.4), maintaining consistent load-bearing capacity unlike absorbable alternatives 3
• This stability makes it particularly valuable in situations where long-term tissue support is required without the risk of suture degradation 3

Clinical Decision-Making Algorithm

When to Choose Ethibond:

1. Permanent tissue support required (thyroid eye disease muscle recessions, large tendon repairs) 1, 2
2. High-tension repairs where long-term strength is critical (diaphragmatic hernia, major tendon injuries) 1, 2
3. Risk of late overcorrection or drift in strabismus surgery 1
4. Load-bearing applications requiring sustained tensile strength beyond 2-4 weeks 3

When to Avoid Ethibond:

• Situations where absorbable sutures are preferred to avoid suture removal (facial repairs, pediatric cases) 1
• Contaminated wounds where multifilament material may harbor bacteria (though this applies to all braided sutures) 7
• Routine closures where permanent suture is unnecessary and may cause chronic foreign body reaction 1