A pledget is a small, specialized piece of medical material, often described as a pad or bolster, used across various clinical settings. A pledget functions as a localized temporary support or permanent accessory designed to manage fluids, apply agents, or reinforce tissue during a procedure. Although they appear simple, their composition and application are engineered to meet specific biological and mechanical demands.
Composition and Physical Description
Pledgets are fabricated from a diverse range of materials, which dictates their primary use as either absorbent or non-absorbent devices. Non-absorbable surgical pledgets are commonly made from synthetic polymers like Polytetrafluoroethylene (PTFE), or Polyester (PET/Dacron) felt. These synthetic materials are non-woven, white, and engineered to be biologically inert, meaning they cause minimal reaction when permanently implanted.
In contrast, pledgets used for temporary applications are often composed of bioabsorbable materials. These can include oxidized regenerated cellulose, gelatin, or specialized foam polymers made from substances like glycolide or lactide. These temporary devices are designed to slowly break down and be absorbed by the body over weeks or months, eliminating the need for later removal. Pledgets are supplied in various pre-cut sizes and shapes, allowing for immediate use in the operating room.
Core Functions in Clinical Use
The functions of pledgets can be broadly categorized into mechanical reinforcement, hemostasis, absorption, and application. The most recognized function in complex surgery is reinforcement, where a pledget acts as a buttress to distribute the tension of a suture across a larger area of delicate tissue. This prevents the suture thread from tearing through fragile or weakened tissue, such as blood vessels or heart walls.
For managing fluids, pledgets provide absorption and hemostasis. Absorbable pledgets made of materials like regenerated cellulose can rapidly soak up blood and other fluids, transforming into a gel-like substance that helps to control localized bleeding. This process promotes coagulation and provides a stable clot, which is especially useful in areas where a surgeon needs a dry field of view. Additionally, pledgets can serve as a vehicle for application, holding and delivering chemical agents, such as hemostatic solutions, to a specific site for local hemostasis or tissue retraction.
Specific Medical and Surgical Applications
Pledgets are most famously employed in cardiovascular surgery, where they are considered a standard accessory for procedures involving the heart and major blood vessels. Surgeons use non-absorbable PTFE pledgets as buttresses when placing sutures in the heart muscle or when repairing heart valves, septal defects, or vascular closures. The pledget ensures the high mechanical stress from heart movement does not cause the sutures to pull through the tissue, providing a permanent and reliable seal.
In dentistry, small pledgets are routinely used to manage bleeding and tissue. These temporary devices are often saturated with a hemostatic solution and placed into a tooth socket or along the gum line to control ooze following an extraction or during a restorative procedure. The material, such as cellulose or gelatin foam, is highly effective at absorbing blood and promoting clot formation in the confined space of the oral cavity. Pledgets are also designed for use in specialized fields like ophthalmology to deliver precise amounts of medication or to support delicate tissues during surgery.
Furthermore, pledgets are critical in various types of general and laparoscopic surgery, particularly when reinforcing suture lines in organs like the liver or during hernia repair. Bioabsorbable foam pledgets are sometimes preferred in these areas because they provide initial support but dissolve over time, leaving no foreign material behind once the tissue has healed. The versatility of these small pads allows surgeons to enhance the stability of their closures across a wide spectrum of surgical challenges.