Types of Suture

Material
Oral and Maxillofacial Surgery Department

Assignment submitted by: Moneezhay Jaffer, Nishwa Asif and Imran Aslam, Group B, Third Year
BDS
What is a suture?
1) Suture material is an artificial fiber used to keep
wound together until they hold sufficiently well by
themselves by natural fiber (collagen) which is
synthesized and woven into a stronger scar.
2) Suture is a stitch/series of stiches made to secure
apposition of the edges of a surgical/traumatic wound
(Wilkins)
3) Any Strand of Material utilized to ligate blood vessels
or approximate Tissues (Silverstein L.H 1999)

WHAT IS THE PURPOSE OF A SUTURE?

The basic purpose of a suture is to hold severed tissues in
close approximation until the healing process provides the
wound with sufficient strength to withstand stress without
the need for mechanical support. Since wounds do not gain
strength until 4-6 days after injury, the tissues are
approximated till then.
Properties of an ideal suture material
 Tensile strength
 Tissue biocompatibility
 Low capillary action
 Good handling and knotting properties
 Sterilization without compromising its properties
 Non- allergic, non-electrolytic and non-
carcinogenic
 Can be used in any operation technique
 Low cost
 Should not fray and should not slip from the tissues
after tying
 Can be visualized easily
Classification of suture materials

A/c to A/c to A/c to

diameter resorbability structure

A/c to A/c to
source coating

1) According to diameter:
 The size of the suture relates to its diameter and is designated by
series of zeros.
 The diameter most commonly used in oral mucosa is 3-0 (000)
 A larger sized suture is 2-0 (00)
 Smaller sizes are designated more
zeros like 4-0, 5-0 and 6-0
 Sutures of size 6-0 is used on the
facial region because they cause
less scarring
 Sutures of size 3-0 is large enough
to withstand the tension place
don them intraorally and strong
enough for easier knot tying with
a needle holder.
 2) According to resorbability:
a) Resorbable:
 These are primarily made up of gut. The term catgut is used
to describe these kinds of sutures but actually these are
derived from serosal surfaces of sheep intestines.
 Plain catgut resorbs quickly in oral cavity (3-5 days)
 Gut that has been treated by tanning solutions is called is
called chromic gut and it lasts for 7-10 days.
 Some synthetic resorbable sutures are also present like
polyglycolic acid and polylactic acid. These take 4 weeks to
resorb and indicated in the oral cavity for basic oral
surgery.
b) Non-resorbable:
 These are silk, nylon, vinyl and stainless steel.
 The most commonly used non-resorbable suture in the oral
cavity is silk.
 Sutures of other material are rarely used in the oral cavity.
 3) According to structure:
a) Monofilament
 These are plain and chromic gut, nylon, and stainless steel.
 Do not cause wicking action
 Difficult to tie and tend to become untied
 Their cut ends are stiffer and are more irritating to the
tongue and soft tissue.
b) Polyfilament
 These are braided sutures such as silk, polyglycolic acid
and polylactic acid.
 Easy to handle and tie and rarely become untied.
 The cut ends are usually soft and no irritating to the tongue
and surrounding soft tissues.
 Due to multiple filaments, they tend to “wick” oral fluids
along the sutures to the underlying tissues. This wicking
action carries bacteria along with saliva.
 4) According to source:
Natural:
 Catgut, chromic catgut, collagen, fascia lata, kangaroo
tendon and beef tendon (Absorbable)
 Silk, silk worm gut, linen, cotton, ramie and horse hair (Non
absorbable)

Synthetic:
 Polyglycolic Acid, polyglactic Acid, polyglactin 910(Vicryl),
polydioxanone(PDS) and polyglecaprone 25 (Absorbable)
 Nylon/ polyamide, polyPropylene, polyesters ,polyethelene,
polybutester ,polyvinylidene fluoride and PVDF Sutures
(Non-absorbable)

Metallic:
 Stainless steel, gold, silver and aluminum.

5) According to coating:
Coated and Un-Coated Sutures

Some types of sutures are available with specialized coatings on the surface
to enhance properties like knotting, easy passage through tissue and
reduce tissue reaction. Normally, coating is applied to braided sutures
rather than monofilament sutures. It is easier to coat braided sutures
compared to monofilaments. Coating materials like chromium salt,
silicon, wax, PTFE, polycaprolactone, calcium stearate. Polymeric
coating materials are known to be more bio-compatible than conventional
coating materials like chromium salts, beeswax, pafaffin, gelatin etc. There
are new functional coatings like antibacterial or antimicrobial coating given
to monofilament and multifilament sutures, stem cell coating for improving
healing properties.

Coated sutures include :- PGA sutures, Catgut Chromic, Polyglactin 910, silk and
polyester sutures, braided or twisted nylon, and Polydioxanone sutures.

Un-coated sutures include :- Monofilament Polypropylene sutures, monofilament

Nylon, PVDF, Stainless steel.

Conclusion:
 One of the most commonly used sutures for the oral cavity
is 3-0 black silk suture.
 The size 3-0 has appropriate
amount of strength.
 The Polyfilament structure of
the silk makes it easy to tie and
well tolerated by the patient’s
soft tissues.
 The color makes the suture easy to see when patient comes
for removal.

References:
1) Contemporary Oral and Maxillofacial Surgery by James R. Hupp,
Edward Ellis III and Myron R. Tucker
2) http://www.slideshare.net/DrAyeshaMaxfac/suture-materials-
suturing-techniques-drayesha
3) http://www.dolphinsutures.com/types-of-sutures