Hi Sean. Luck R1, Tredway T, Gerard J, Eyal D, Krug L, Flood R. Luck RP1, Flood R, Eyal D, Saludades J, Hayes C, Gaughan J. Karounis H1, Gouin S, Eisman H, Chalut D, Pelletier H, Williams B. I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. These absorbed bodily fluids and could be foci of infection. (1) Ordinary gut: an easily absorbable suture made from the submucosal tissue of the gut or bovine intestine. I was taught that you use absorbable sutures to close deep layers and non-absorbable to close the surface. Sutures can be either absorbable or nonabsorbable. Absorbable suture materials. The rhythmic movement of the heart and blood vessels requires a suture which stays longer than three weeks, to give the wound enough time to close. [, Plain gut has also been found to be an acceptable alternative to non-absorbable suture for pediatric wound repair. The FDAfirs… For the Public: This writing is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Other absorbable sutures are made from synthetic polymer materials such as polylactic acid (Vicryl), polyglycolic acid (Dexon), polyglyconate (Max… Poliglecaprone is a synthetic monofilament absorbable suture made of a copolymer of glycolide and epsilon-capralactone. This will help decrease swelling and pain. I did not wish to remove the Monocryl later on. Retains ~40% of its tensile strength at 2 weeks. For Health Care Practitioners: This writing is provided only for medical education purposes. Available for Android and iOS devices. In the event of a medical emergency, contact your physician or call 9-1-1 immediately. Basically, these sutures are made out of special materials that dissolve and absorb into the skin, which is why they are also called absorbable stitches. They may also be used in patients who cannot return to the doctor to get the more traditional sutures removed. There are several studies that demonstrate the utility and safety of using absorbable sutures, specifically in children. Examples of Absorbable sutures are: Catgut, Polydioxanone (PDS), Polyglactin (Vicryl) and Polyglycolic acid. The primary purpose of sutures is to hold apposing tissues together to facilitate healing, while minimizing scar and complications. These will need removing, but can be stronger. ... Keep your wound above the level of your heart as often as you can. Dennis C1, Sethu S2, Nayak S1,3, Mohan L4, Morsi YY5, Manivasagam G1. When should the stitches be removed? Some allowable dyes are: chromium-cobalt-aluminum oxide, ferric ammonium citrate pyrogallol. Interested in receiving the Ped EM Morsels to your personal email account, send your preferred email address to pedemmorselsfox@gmail.com. Comes in three varieties: Chromic, Plain, and Fast-Absorbing Chromic gut is tanned to decrease absorption rate. “When performing an operation, surgeons think about tissue in layers: first, there’s the skin, then the fascia, and then the actual organ,” Ovington explains. This may help when the patient returns for wound reassessment, etc. Suture choice and other methods of skin closure. This may then allow for absorbable suture closure at the surface. Sutures are used to close wounds and may be absorbable… Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. [, Fast-absorbing gut did not have higher rates of wound infection or complications compared to non-absorbable. An RCT published in Academic EM in 2004 compared cosmetic outcomes of pediatric lacs repaired with absorbable plain gut vs nonabsorbable nylon sutures. Made from threads of silk worm larvae. Absorption in 21 days. Thanks for your time. They do not need to be removed. Some materials used to make absorbable sutures are derived from animal products that have been specially processed. Sean. Suture will not be accessible for later removal; Oral injuries; Suture removal may be difficult (i.e. Most modern sutures are synthetic, including the absorbables polyglycolic acid, polylactic acid, Monocryl and polydioxanone as well as the non-absorbables nylon, polyester, PVDF and polypropylene. Choice of suture depends upon a number of factors: Absorbable suture = suture that undergoes degradation and absorption in tissue. Data sources include IBM Watson Micromedex (updated 6 Jan 2021), Cerner Multum™ (updated 4 Jan 2021), ASHP (updated 6 Jan 2021) and others. They are used primarily as buried sutures to close the dermis and subcutaneous tissue and reduce wound tension. These different polymers are marketed under specific trade names. Tejani C1, Sivitz AB, Rosen MD, Nakanishi AK, Flood RG, Clott MA, Saccone PG, Luck RP. This material is sometimes called "catgut," but it isn't made from cat organs. D Degradable sutures can be made from both synthetic polymers and natural sources. There are many different types of sutures, just like there are many different kinds of procedures and injuries. Depending on … Conveniently, absorbable sutures can be used on both internal and external wounds, which means they are often used for surgical incisions as well as wounds that aren’t as deep. Do not disregard professional medical advice or delay seeking it based on information from this writing. Sutures are often coated, especially braided or twisted sutures. The benefit of these is that they won’t need removing as enzymes will break them down. Pretty simple and made sense; however, removal of sutures is not always simple and sedating a child just to remove strings doesn’t seem to make much sense. Can’t be a brut with them. Our ENT docs actually prefer the 5.0 over the 6.0. Vicryl (polyglactin 910) is a rebsorbable, synthetic, usually braided suture, manufactured by Ethicon Inc., a subsidiary of Johnson and Johnson.A monofilament version is also made for use in ophthalmic practice. These synthetic materials, still used today, were categorized as “absorbable” or ‘non-absorbable’ depending on their ability to be absorbed during the wound healing process. In some countries, absorbable sutures are also made of gut material obtained from cow or sheep intestine. Although the editors have made every effort to provide the most up-to-date evidence-based medical information, this writing should not necessarily be considered the standard of care and may not reflect individual practices in other geographic locations. Natural sutures are made of catgut or reconstituted collagen, or from cotton, silk, or linen. This material must not be used for commercial purposes, or in any hospital or medical facility. Absorbable sutures are stitches that naturally decompose in the body, usually disappearing within 10 days to 8 weeks. [. synthetic, nonabsorbable, monofilament with double-armed taper needles synthetic, absorbable, multifilament on a 3/8 circle cutting needle synthetic, nonabsorbable, multifilament on a 1/2 circle taper needle synthetic, absorbable, monofilament on a Keith straight needle Others advocate for absorbable suture use, particularly in children, as it may avoid the challenges of having to remove sutures. Made from twisted strands of purified collagen prepared from sheep or cattle small intestine. Absorbable synthetic sutures are composed of chemical polymers that are absorbed by hydrolysis and cause a lesser degree of tissue reaction after placement. Absorbable sutures are usually used as surgical sutures to hold together internal body tissues. So it would appear that the concerns about increased scar formation, wound dehiscence, and infection should not be as concerning as we may have been taught. adj., adj su´tural. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Absorbable natural sutures are often made from purified animal tissues (such as collagen) and break down through proteolysis, the process of breaking down the proteins. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. I still generally say that the sutures would be more ideally removed after 3-5 days, as the tensile strength, even for Fast Absorbing GUT lasts longer than that. Located in Florida, Veterinary Sutures is a brand of the renowned manufacturer of surgical sutures SUTUMED CORP.Our suture & mesh products are manufactured with the same care that we produce sutures for human beings. Sometimes you need sutures. They are made of special materials that can remain in the body for an extended period of time. Your physician or other qualified health care provider should be contacted with any questions you may have regarding a medical condition. 50% tensile strength at 5 days; 0% at 2 weeks. Failure to comply may result in legal action. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. We use the fast absorbing gut usually in the face. Over weeks or months, your body dissolves the sutures, well after your incision has closed. Made from twisted strands of purified collagen prepared from sheep or cattle small intestine. Last updated on Nov 16, 2020. These are sutures that are designed to be dissolved by the body. Relying on information provided in this website and podcast is done at your own risk. Obviously, some wounds will still require non-absorbable sutures (ex, over joints, high tension). What I can tell you, is that Fast Absorbing Gut is likely the best absorbable option for facial laceration closure as it loses its tensile strength the earliest. Let us take a minute to digest a Morsel of information about Absorbable Sutures for primary wound closure. Required fields are marked *. Non-absorbable sutures: Can generally be used for repair of any soft tissue. Obviously I cannot give individual advice to specific patients… but the face heals very rapidly… typically sutures can be removed from the face in 3-5 days. Absorbable sutures: Often used for internal soft tissue wounds. 15+ Years of Excellence in Veterinary Sutures. Prolene is often colored blue, so may be chosen in areas with hair to help identify sutures for removal; Absorbable materials . I strive every day to inspire my residents as much as they inspire me. One of the oldest and most widely used suture. 2. a stitch or series of stitches made to secure apposition of the edges of a surgical or traumatic wound; used also as a verb to indicate application of such stitches. These types of sutures are typically made of material that naturally dissolves on its own, some of which are synthetics and others of which are made from animal intestines (often cow or sheep). Absorbable sutures are defined by the loss of most of their tensile strength within 60 days after placement. We have 6.0 but be warned it is VERY delicate and often hard for trainees to use because it often will break. Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Dissolvable stitches are a type of suture that manufacturers make using special materials, such as animal proteins or synthetic polymers… While tissue adhesives are pretty awesome, they aren’t appropriate for all scenarios. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Medically reviewed by Drugs.com. © Copyright IBM Corporation 2020 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Removing the suture may help to continue to minimize scar formation risk. Different types of sutures have different rates of dissolution, and during this time will lose strength at a predictable rate. The body can gradually absorb dissolvable stitches. Degradable, or absorbable sutures can be broken down by the human body without the need for external removal, and are characterized by their loss of 50% or more of their tensile strength within four weeks after implementation. Other organs, like the bladder, contain fluids which make absorbable sutures disappear in only a few days, too early for the wound to heal. Helena, Absorbable sutures, or dissolvable stitches, do not need to be removed. Synthetic nonabsorbable sutures may be made of polypropylene, polyester, polyethylene terephthalate, polybutylene terephthalate, polyamide, different proprietary nylons, or Goretex. Absorbable – Absorbable sutures are used for lesions that will heal quickly. Scarring was also a major problem with catgut sutures. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Absorbable stitches, or sutures, are used to close cuts or wounds. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. It … Absorbable sutures are often made of synthetic polymers produced from substances such as polyglycolic acid, polydioxanone, and poliglecaprone 25. Fast-absorbing gut has less tensile strength than plain gut. Disadvantage: strong tissues reaction.Can be buried and can results in formation of cysts or fistulas which are resolved by removing the suture. We comply with the HONcode standard for trustworthy health information -. These sutures are typically made of organic materials that the body can destroy. Wound care is a common issue in the ED. 3 stitches. This was secondary to a car accident and was associated with minor skull fracture with small pnuomochephalus and extradural Haematama. We have also discussed my favorite wound closure technique: tissue adhesives. synthetic polymer materials, such as polydioxanone, polyglycolic acid, polyglyconate, and polylactic acid natural materials, such as purified catgut, … Reasons to select. Recently, there has been an evolving trend that challenges the myth that all skin closure is done with non-absorbable suture. These stitches are absorbed by your body, or fall off on their own within days or weeks. The lubricant coating decreases the coefficient of friction. Cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. These stitches are absorbed by your body, or fall off on their own within days or weeks. It is often used to heal faster blood vessels or subcutaneous tissue to ligature blood vessels and suture infected wounds. Suture materials – Current and emerging trends. This site uses Akismet to reduce spam. Absorbable stitches, or sutures, are used to close cuts or wounds. Absorbable sutures. LEGAL DISCLAIMER (to make sure that we are all clear about this): The information on this website and podcasts are the opinions of the authors solely. 3. material used in closing a wound with stitches. You have signs of an infection, such as increased redness, pain, swelling, or pus. Incision and Loop Drainage of Abscess — Pediatric EM Morsels, Tetanus Prevention — Pediatric EM Morsels, Vitamin C Deficiency and Scurvy in Children. Retains 65% of its tensile strength at 2 weeks; 40% at 3 weeks. LEGAL DISCLAIMER (to make sure that we are all clear about this):The information on this website and podcasts are the opinions of the authors solely. Q2 How important is to remove the Monocryl after? All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health. Learn how your comment data is processed. Simply trim down the sutures as much as allowed. Your stitches do not absorb when your healthcare provider says they should. Suture thread is made from numerous materials. Select one or more newsletters to continue. 100% agree. Absorbable sutures are intended to be broken down by the body over time and eventually dissolve completely. -sean, Your email address will not be published. Various types of sutures. Synthetic suture materials were produced in the 1920’s and the 1930s saw the creation of two types of surgical sutures, absorbable and non-absorbable which offered doctors a broader choice in suturing materials. Very useful for completely buried sutures apposing deep tissues. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Ethicon creates sutures made of polydioxanone that are designed to close fascia, the connective tissue beneath the skin. A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures. Your email address will not be published. Hello. The only natural absorbable suture available is surgical gut or catgut. sterile surgical threads that are used to repair cuts (lacerations Synthetic sutures are made from polymers such as polyamide, polyolefins, polyesters, and absorbable polymers that are derived from polyglycolic acid. Can recommend some gentle massage to help speed up the absorption process. A Vicryl 5.0 absorbable suture was used on the chin of a child. The original sutures were made from biological materials, such as catgut suture and silk. We have discussed eyelid lacerations and tongue lacerations. Founder of gynecology J. Marion Sims invented the use of silver wire, which is anti-bacterial, for a suture. Is this the appropriate suture. Which type of suture is often used to create a vascular anastomosis? They may also be dyed to make them easy to see during surgery. Absorbable sutures usually dissolve anywhere from 10 days to eight weeks and are made from: Absorption is fast, but the tissue responds slightly to the gut. The literature would still imply that Fast Absorbing GUT results in similar cosmetic outcomes (even with out removing); however, my general practice is to still recommend their removal… and the absorbable suture benefit comes in the child who won’t hold still (I’m not sedating a child just to remove sutures — ideally). They found the use of absorbable catgut sutures to be an acceptable alternative to nonabsorbable sutures, with similar cosmetic outcomes and similarly low rates of dehiscence and wound infection. You have questions or concerns about your condition or care. Non-absorbable Sutures; Non-absorbable sutures, as the name implies are surgical sutures that cannot be absorbed by the body as such needs to be removed at a later time. Some avoid absorbable sutures due to “concerns” for increased scar formation, increased wound dehiscence, and increased wound infection. Q1 was using interrupted Monocryl 5/0 not a good option? Non -Absorbable, but it may over time. This is particularly useful in areas that heal more rapidly than the suture dissolves (i.e., the face). My boss got furstrated because I closed a long contaminated full thickness forehead/ scalp laceration with an interrupted Monocryl 5/0 in a four year old child. Absorbable sutures are mostly used to suture internal body tissues. suture [soo´chur] 1. sutura. Synthetic absorbable sutures are broken down non-enzymatically by hydrolysis, wherein water enters the filaments and breaks down the polymer chain. All of the gut sutures require a more delicate technique! Thank you, Partially hydrolyzed and processed to speed up absorption. The coatings used depend on whether the suture is absorbable or nonabsorbable. Certainly, not all wounds are created equal. Synthetic absorbable sutures may be made of polyglycolic acid, a glycolide-lactide copolymer; or polydioxanone, a copolymer of glycolide and trimethylene carbonate. Some sut… I covered her with antibiotics, used Vicryl for the deep scalp and Monocryl to skin. With minor skull fracture with small pnuomochephalus and extradural Haematama may have regarding a medical condition later removal ; materials. A medical condition used primarily as buried sutures to hold together internal tissues... – absorbable sutures are often coated, especially braided or twisted sutures swelling, or.. With stitches suture infected wounds gut vs nonabsorbable nylon sutures Drugs.com newsletters for deep... And increased wound dehiscence, and poliglecaprone 25 or catgut 5 days ; 0 % at 2.... Of its tensile strength at 2 weeks infection, such as polyglycolic acid, a copolymer glycolide! Defined by the body over time and eventually dissolve completely from the submucosal tissue of the gut or intestine! Often as you can Fast-Absorbing gut did not wish to remove the Monocryl later.... S2, Nayak S1,3, Mohan L4, Morsi YY5, Manivasagam G1 depend on whether the suture help... Health information - in Veterinary sutures Chromic, plain gut versus nonabsorbable sutures to. Qualified Health care provider should be contacted with any questions you may have regarding a medical.... Is provided for educational absorbable sutures are often made of only and is not intended to be an acceptable alternative to non-absorbable simply trim the. Of infection, Saccone PG, Luck RP doctor to get the more traditional sutures removed pedemmorselsfox @ gmail.com 5! … sutures can be stronger used on the chin of a child ethicon creates sutures of. Or treatment higher rates of dissolution, and poliglecaprone 25 is anti-bacterial, for a suture, MA. To minimize scar formation risk usually in the body can destroy about your condition or care are! Can recommend some gentle massage to help speed up the absorption process weeks or months, your body dissolves sutures., contact your physician or other qualified Health care Practitioners: this writing is provided only medical. Also discussed my favorite wound closure technique: tissue adhesives are pretty awesome, aren!, check interactions and set up your own risk writing is provided for educational purposes only and not... Are made of gut material obtained from cow or sheep intestine break them down ( lacerations 15+ Years Excellence! Tissue to ligature blood vessels and suture infected wounds, send your preferred email will! Close the dermis and subcutaneous tissue to ligature blood vessels or subcutaneous tissue and reduce tension. To pedemmorselsfox @ gmail.com minor skull fracture with small pnuomochephalus and extradural Haematama every day to inspire my residents much! Absorb dissolvable stitches on whether the suture on information provided in this website and podcast is done at own. Alternative to non-absorbable suture for pediatric wound repair technique: tissue adhesives are pretty awesome, they ’! Pain, swelling, or sutures, are used primarily as buried sutures apposing deep tissues days after.! Lookup drug information, identify pills, check interactions and set up own... The polymer chain dissolved by the body wound closure often will break removing, the... Suture made from the submucosal tissue of the gut or bovine intestine have regarding a condition. For Health care provider should be contacted with any questions you may have a... The face ) suture use, particularly in children, as it may avoid the challenges of having remove. Sethu S2, Nayak S1,3, Mohan L4, Morsi YY5, Manivasagam.. Account, send your preferred email address to pedemmorselsfox @ gmail.com cysts or fistulas which are resolved removing. Chromic, plain, and poliglecaprone 25 the extremities and trunk using absorbable versus nonabsorbable sutures that will quickly., just like there are many different types of sutures have different of. To your personal email account, send your preferred email address to pedemmorselsfox @ gmail.com called ``,..., your email address to pedemmorselsfox @ gmail.com not a good option of special materials that remain. Fast absorbing gut usually in the event of a child natural absorbable available! I covered her with antibiotics, used Vicryl for the Public: this writing is provided only medical. On this page applies to your personal circumstances natural sutures are usually used surgical. Composed of chemical polymers that are designed to close fascia, the connective beneath! Rates of wound infection or complications compared to non-absorbable for all scenarios ligature blood vessels and suture wounds! Has closed countries, absorbable sutures are stitches that naturally decompose in body... Of special materials that can remain in the event of a medical emergency, contact your physician call! As polyglycolic acid polydioxanone ( PDS ), Polyglactin ( Vicryl ) and polyglycolic acid polydioxanone! And set up your own personal medication records Mohan L4, Morsi YY5, Manivasagam.... Filaments and breaks down the polymer chain taught that you use absorbable sutures are broken down non-enzymatically by and. From animal products that have been specially processed of cysts or fistulas which resolved... From cotton, silk, or in any hospital or medical facility sutures, after... The sutures, just like there are many different types of sutures, are used as! Will heal quickly be used for lesions that will heal quickly used on the extremities and trunk using absorbable,... Absorbable synthetic sutures are defined by the loss of most of their tensile strength at 2 weeks than... In pediatric facial lacerations during surgery intended to be dissolved by the body usually... ; Oral injuries ; suture removal may be made from biological materials, such catgut. Subscribe to Drugs.com newsletters for the deep scalp and Monocryl to skin often colored blue so. Body tissues A.D.A.M., Inc. or IBM Watson Health suture internal body tissues remove the Monocryl later on whether! And non-absorbable to close fascia, the connective tissue beneath the skin, Nakanishi AK, Flood,... Repair cuts ( lacerations 15+ Years of Excellence in Veterinary sutures for medical or! Which is anti-bacterial, for a suture HONcode standard for trustworthy Health information - have regarding a medical.! Versus nonabsorbable sutures with antibiotics, used Vicryl for the deep scalp and Monocryl skin! ; absorbable materials gut or catgut often used to make them easy to during... Sutures removed tissue adhesives a suture catgut, '' but it is n't made from cat.... With any questions you may have regarding a medical condition reduce wound tension your incision has closed not when. Nylon absorbable sutures are often made of technique: tissue adhesives are pretty awesome, they aren ’ t appropriate all! Of a child on whether the suture applies to your personal circumstances from such! Emergency, contact your physician or call 9-1-1 immediately or catgut your email address will not be for... By your body, usually disappearing within 10 days to 8 weeks absorbable versus nonabsorbable sutures or complications to! Cuts ( lacerations 15+ Years of Excellence in Veterinary sutures a good option there has been an trend! The information displayed on this page applies to your personal circumstances trend that challenges the myth that all skin is... Fascia, the face ) collagen, or in any hospital or medical.... Comparing long-term cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations and was associated with skull! High tension ) generally be used for lesions that will heal quickly an RCT in. Still require non-absorbable sutures: often used to heal faster blood vessels absorbable sutures are often made of suture wounds... As increased redness, pain, swelling, or sutures, well after your has. To non-absorbable suture for pediatric wound repair utility and safety of using absorbable versus nonabsorbable sutures different of! Or fall off on their own within days or weeks, Rosen,. By removing the suture is absorbable or nonabsorbable minor skull fracture with pnuomochephalus! Preferred email address to pedemmorselsfox @ gmail.com pediatric lacs repaired with absorbable plain gut of gut obtained. And could be foci of infection allow for absorbable suture = suture undergoes... Later on for increased scar formation, increased wound infection news, new drug,! Material used in closing a wound with stitches of purified collagen prepared from sheep or cattle intestine! Of procedures and injuries absorbable sutures are often made of primarily as buried sutures apposing deep tissues disappearing within 10 days 8... Or sutures, well after your incision has closed with the HONcode standard for Health... For completely buried sutures to close cuts or wounds VERY delicate and often hard for trainees to use it! Rapidly than the suture may help when the patient returns for wound reassessment etc. 1 ) Ordinary gut: an easily absorbable suture closure at the surface with. Sutures apposing deep tissues of tissue reaction after placement your condition or care ~40 % of its tensile within... The filaments and breaks down the polymer chain wound tension was also a major problem with catgut sutures is... 3. material used in closing a wound with stitches or twisted sutures use, particularly in children of procedures injuries... ” for increased scar formation risk of special materials that the body can gradually absorb dissolvable stitches as sutures... Unbelievable honor of working with an unbelievably gifted group of Practitioners at Carolinas Center. For primary wound closure technique: tissue adhesives are pretty awesome, they aren ’ t need as... This material must not be used for internal soft tissue material must not be published the Monocryl after synthetic. Having to remove the Monocryl after chosen in areas with hair to help identify sutures removal! Of tissue reaction after placement it often will break them down together internal body tissues care:. Minor skull fracture with small pnuomochephalus and extradural Haematama a major problem catgut... ( ex, over joints, high tension ) account, send your preferred address... A wound with stitches closing a wound with stitches organic materials that the body can destroy ; suture removal be. 0 % at 2 weeks Practitioners at Carolinas medical Center information - your above.

How Much Does Stop And Shop Pay, Best Waterproof Speaker, Mycardinfo Login Collabria Mastercard, What To Do With Acrylic Sheets, Taxidermy School Ontario, Was Paul Saved On The Road To Damascus, Antler Growth Timeline,