A pledget is a small piece of medical material used primarily in clinical settings to reinforce tissue, manage bleeding, or apply localized pressure. This versatile accessory serves as a mechanical aid, often paired with sutures or other surgical tools, to enhance the security and integrity of a repair site. Pledgets are designed to support fragile biological structures and prevent complications like tissue tearing or fluid leakage.
Defining the Pledget
A pledget is typically a small, compressed, or woven piece of material designed to function as a buttress or localized pad. These devices are most often manufactured from synthetic polymers, such as Polytetrafluoroethylene (PTFE), known commercially as Teflon, or Polyester, sometimes called Dacron felt. The use of synthetic, non-absorbable materials like PTFE is common because they are biologically inert and provide durable mechanical support. Pledgets can also be made from natural materials, such as bovine pericardium, or from absorbable synthetics like polyglycolide (PGA) for applications where temporary support is preferred. They are available in various shapes, including circular, rectangular, or oval, and come in numerous sizes.
Primary Mechanical Functions
The core role of a pledget is to provide localized mechanical support, which involves distributing tension or pressure over a wider surface area of delicate tissue. When a surgeon places a suture through fragile tissue, the force of the knot can cause the suture thread to tear through the material, a complication known as “suture pull-through.” The pledget acts as a washer, buttressing the suture and spreading the localized tension across its entire surface, preventing the thread from cutting through the tissue. This mechanism is crucial for reinforcement in tissues subject to high mechanical loads, like the heart or major blood vessels. Beyond reinforcement, the pledget functions as a sealing agent, helping to achieve hemostasis (control of bleeding) or manage leaks at the suture line.
Common Clinical Applications
Pledgets are used across several surgical specialties where tissue integrity is a concern. A significant area of use is in cardiovascular surgery, where they are routinely employed as suture buttresses for repairs involving vascular grafts, heart valves, and the ventricular myocardium. For example, they support the fragile edges of the heart muscle during septal or myocardial repair procedures, ensuring sutures hold securely under the constant stress of heart contractions. Pledgets are also utilized in general and minimal access surgery for reinforcing suture lines in delicate areas, such as during hernia repair or laparoscopic procedures. In dental and aesthetic dermatology, pledgets made of gauze or cotton may be used as a small compress to absorb fluid or provide localized compression following minor procedures.