Pledgets are small masses of material used in medicine to aid in various procedures. They function primarily as a tool for precise application, absorption, or mechanical support in delicate biological environments. Their utility spans general surgical applications to highly specialized fields, such as cardiovascular and ophthalmic surgery.
Defining Pledgets and Their Composition
A pledget is a small medical object, often resembling a tiny patch or felt square. They are typically available in various shapes, including oval, rectangular, or circular, to suit differing procedural needs. Some pledgets are designed with a fixed thickness for structural supports, while others are less uniform and more akin to tufts of material.
The materials used for pledgets vary based on their intended function. Non-absorbable synthetic materials, like Polytetrafluoroethylene (PTFE) or polyester (PET), are commonly used for applications requiring permanent structural support. These materials are inert, meaning they do not dissolve or degrade inside the body. Conversely, absorbable materials, such as cotton, gauze, or specialized gelatin, are used when the item needs to be temporary, such as for fluid management or drug delivery.
General Roles in Medical Procedures
Pledgets have broad applications where localized interaction with tissue is required. One common use is for achieving localized hemostasis, which is the stopping of minor bleeding. Their small size allows a surgeon to apply pressure or a hemostatic agent directly to a small bleeder without affecting the surrounding area.
The absorptive capacity of materials like cotton makes them ideal for managing fluids in delicate procedures, such as those performed in ophthalmology or dentistry. Pledgets can precisely soak up excess blood, saliva, or irrigation fluid to maintain a clear field of view. Furthermore, pledgets serve as a vehicle for topical drug delivery. They are often saturated with medications, such as epinephrine, a vasoconstrictor, and placed directly onto tissue to achieve a localized pharmacological effect.
Use as Suture Buttresses in Surgery
A primary function of pledgets is their role as a suture buttress, particularly in procedures involving fragile or thin tissue. The pledget acts as a cushion to distribute the tension of a suture across a wider surface area of the tissue. This prevents the suture thread from tearing through the tissue, a complication known as “cheese-wiring,” which is important in organs with delicate walls or high mechanical stress.
The application of pledgets as buttresses is common in cardiovascular surgery for procedures like septal repair, valvular suturing, or vascular closure. Non-absorbable synthetic materials like PTFE felt are typically used to provide permanent support to the suture line. The pledget is placed on the external surface of the tissue, and the suture is passed through both the pledget and the tissue wall before being tied.
This technique, referred to as a “pledgeted suture,” is also used in surgeries like hiatal hernia repair, where the diaphragm tissue can be thin or damaged. Using a pledget disperses the force of the tightened suture, offering mechanical stability and improving the long-term integrity of the repair. The use of these buttresses allows for a more secure and tighter approximation of tissue segments in high-pressure or friable environments.