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Suture materials: composition and applications

in vetern‐ary wound repair

ARTICLE in AUSTRALIAN VETERINARY JOURNAL · FEBRUARY 2003

Impact Factor: 1.05 · DOI: 10.1111/j.1751-0813.2003.tb11075.x

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Clinical
Suture materials: composition and applications in vetern-
ary wound repair
RHH TAN, RJW BELL, BA DOWLING and AJ DART
University Veterinary Centre Camden, The University of Sydney, 410 Werombi Road, Camden, New South Wales 2570
Suture materials play an important role in veterinary surgery
by providing support for healing tissues during wound repair.
As there is no single ideal suture material, clinicians must
compromise on some properties when selecting a material for
a specific purpose. By reviewing the characteristics of
absorbable and non-absorbable materials, general recom-
mendations can be made on their usage in skin, fascia,
viscera and other tissues.
Aust Vet J 2003;81:140-145
PGA Polyglycolic acid
PDS Polydioxanone
S
uture materials play an important role in wound repair by
providing support for healing tissues. Common applica-
tions for suture materials in veterinary surgery include:
closure of fascia and skin, haemostasis, intestinal anastomosis
and enterotomy, urogenital tract surgery and, less commonly,
vascular surgery. The general performance of a suture material is
based on its physical characteristics, handling characteristics and
biological properties. An ideal suture material could be utilised
for any purpose, with good handling characteristics, knot secu-
rity and tensile strength. It should be sterile, non-electrolytic,
non-ferromagnetic, non-capillary, non-allergenic, non-carcino-
genic and should not provide a medium for bacterial growth.
Furthermore, any ideal suture material should be resistant to
shrinkage, absorbed with minimal tissue reaction, easy to ster-
ilise without alterations in its properties, and economical to
use.1 No single material will meet all these criteria in every
circumstance, so a compromise must be reached by the clini-
cian. Clinicians should aim to select a material that has a high
strength to diameter ratio, is of a consistent diameter, sterile and
pliable, with optimal tissue acceptance and predictable perfor-
mance. Suture cassettes are often used in veterinary practice
because they are less expensive than pre-packaged material.
Disadvantages include decreased efficiency, the need for eyed
needles, increased risk of contamination, and limited selection
of material. The purpose of the following review is to provide a
summary of relevant suture materials, with general recommen-
dations for use in veterinary practice. In this article, suture
materials are categorised into absorbable and non-absorbable
materials, with all sizes in United States Pharmacopoeia (USP).
Classification of suture materials
Suture materials are classified as absorbable or non-
absorbable, natural or synthetic, and monofilament or multifil-
ament, according to their composition and structure.
Absorbable suture materials are defined as materials that lose
their tensile strength within 60 days of implantation.3 Natural
materials are absorbed through enzymatic degradation, whilst
newer synthetic absorbable sutures are absorbed through non-
enzymatic hydrolysis. In non-enzymatic hydrolysis, the poly-
140
mers are divided to monomers by direct water cleavage and the
monomers are then metabolised to carbon dioxide and water.4
The advantage of new synthetic sutures is that, during the
process of non-enzymatic hydrolysis, absorption rates are not
significantly affected by the presence of infection or inflammation.5
Absorbable suture materials used in veterinary practice
include: surgical gut, polyglactin 910, polyglycolic acid, poligle-
caprone 25, polydiaxanone, polyglyconate and panacryl (Table 1).
Non-absorbable suture materials are those not significantly
degraded after implantation and are used where extended
wound support is required. Natural fibres tend to invoke signif-
icant inflammatory reactions, thus the preference for synthetic
non-absorbable sutures. Care should be taken when using mul-
tifilament non-absorbable materials due to their inherent capil-
larity and tendency to form draining sinus tracts in infected
wounds. Non-absorbable suture materials used in veterinary
surgery include: silk, polybutester, polyester, nylon, polypropy-
lene and stainless steel (Table 2). Other materials used for
wound support in veterinary practice include tissue adhesives
and tissue staples.
Absorbable suture materials
Surgical gut (Gut®, Chromic Gut®)
Surgical gut is a natural, absorbable, multifilament suture
material prepared from purified connective tissue derived from
either the submucosa of sheep intestines or the serosal layer of
bovine intestines. Gut evokes a moderate inflammatory reaction
in tissue as it is broken down through a combination of enzy-
matic degradation and phagocytosis. The rate of absorption is
significantly increased in the presence of infection and in tissues
with high levels of proteolytic enzymes.6 Chromic coating
reduces the soft tissue reaction and the rate of absorption.
Chromic gut is difficult to handle, has a tendency to fray with
handling and has poor knot security when wet.7 It is important
to place at least four throws at the start of a continuous suture
pattern and five at the end.8 Chromic gut was commonly used
in small animal general practice as it is inexpensive and available
in multiple-use reels.9 However these reels have an increased
contamination risk,10 and chromic gut has been superseded by
newer absorbable sutures.
Polyglactin 910 (Vicryl®; Vicryl Rapide®)
Coated Vicryl Rapide® and coated Vicryl® are made from a
co-polymer of 90% glycolide and 10% L-lactide. Vicryl® is a
braided multifilament suture material with a greater initial ten-
sile strength than either surgical gut or polyglycolic acid.11 It
elicits minimal inflammatory reaction and is absorbed through
hydrolysis.10 With good handling characteristics and size to
strength ratio, it may be used in a variety of tissues, including
infected wounds.11 Size 3 coated Vicryl® is the strongest
absorbable suture material available and is recommended for the
closure of midline laparotomies in horses.12
Aust Vet J Vol 81, No 3, March 2003
 Clinical

Table 1. Biomechanical characteristics and applications of absorbable suture materials in veterinary practice.

Suture Type Strand Tensile Strength Uses Contraindications Disadvantages Sizes

Gut®, Chromic gut® Multifilament None remaining at Subcutaneous and other Tissues with high levels Poor knot security 3 to 7-0
(Ethicon) approx 21-28 days rapid healing tissues of proteolytic enzymes when wet, variable
inflammatory reaction absorption time
may be desirable in
some instances

Polyglactin 910 Braided 60% lost at 14 days Contaminated wounds, May cut through 3 to 8-0
(Coated Vicryl®, multifilament Absorbed by 70 days, linea alba in horses, delicate or friable (*1 to 5-0)
*Vicryl Rapide®; *Tensile strength lost gastrointestinal tract, tissues
Ethicon) at 10-14 days and urinary tract
absorbed by 42 days

Polyglycolic acid Braided 80% lost at 14 days Intestinal anastomosis, Oral cavity or in High tissue drag 2 to 6-0
(Dexon®, Dexon II®; multifilament Absorbed by 60 days ceasarian section , alkaline environments and prematurely
Davis & Geck) hernia repair dissolved in urine

Polydioxanone Monofilament 26% lost at 14 days
(PDS II®; Ethicon), Loss of tensile strength
slower than Dexon
or Vicryl.
Absorption complete
at 6 months
In sterile or infected Higher memory and 2 to 9-0
urine or where poor knot security
extended wound support
with absorbable
suture is desirable

Poliglecaprone 25 Monofilament 30-40% lost at 14 days Bladder surgery, More tissue drag 2 to 6-0
(Monocryl®; Ethicon) subcutaneous closures then PDS

Polyglyconate Monofilament 20% lost at 14 days
(Maxon®; Three times stronger
Davis and Geck) than vicryl at 21 days
Absorption complete
at 6 months
Tendon repair or where More rapid absorption 2 to 7-0
extended wound support in urine compared
with absorbable suture to PDS
is desirable

Panacryl (Ethicon) Multifilament 20% lost at 90 days Tendon or ligament Urinary or biliary tract, 2 to 3-0
repairs and orthopaedics cardiovascular tissue

Table 2. Biomechanical characteristics and applications for non-absorbable suture materials available for veterinary practice

Suture Type Strand Tensile Strength Uses Contraindications Disadvantages Sizes

Silk (Permahand®, Braided 50 % of initial tensile Ophthalmic surgery Contaminated wounds, Marked tissue 5 to 9-0
Mersilk®;Ethicon) multifilament strength lost at 365 days epithelium of hollow reaction
viscera

Polybutester (Novafil®; Monofilament No appreciable loss Fascia, tissues where 2 to 10-0

Davis & Geck) of tensile strength wound healing may
be prolonged, tendons

Polypropylene Monofilament Low tensile strength Skin, blood vessel Infected wounds High memory, poor 5 to 8-0
(Prolene®; Ethicon) knot security

Polyester (Mersiline®, Braided No appreciable loss Used to provide support Hollow viscus Highest tissue 5 to 11-0
Ethibond®; Ethicon, multifilament of tensile strength , in slow healing tissues reaction of any
Surgilene®, Surgidac®; one of the strongest synthetic suture
Davis and Geck) non metallic sutures

Nylon (Ethilon®, Monofilament Stronger than silk or Tendon, nerve, skin Serosa or within Poor handling and 2 to 11-0
Nurolon®; Ethicon, or multifilament polypropylene synovial cavities knot security
Dermalon®, Supramid®, Monofilament:
Monosof®, Surgilon®; 30% loss by 2 years
Davis & Geck) Multifilament: 100% loss
by 6 months

Stainless Steel® Mono or Greatest tensile strength Good for slow Highly mobile sites Poor handling and 7 to 10-0
(Ethicon) multifilament of all sutures healing tissues tends to cut tissues

Coated Vicryl Rapide® is also a braided multifilament mate-
rial, with approximately 66% of the initial tensile strength of
Coated Vicryl.13 Its performance characteristics in vivo are
designed to mimic those of surgical gut without the associated
inflammatory reaction. Vicryl Rapide® loses tensile strength and
mass faster than Vicryl® and is more rapidly absorbed. When
used in the mucous membranes or skin, it begins to slough in
approximately 7 to 10 days. It is suitable for tissues that heal with
a rapid increase in tensile strength and where long-term support
is not required, such as the urinary or gastrointestinal tract.

Aust Vet J Vol 81, No 3, March 2003 141

Clinical
Polyglycolic acid (Dexon®, Dexon II®)
Dexon® and Dexon II® are braided multifilament suture
materials made from a synthetic polyester polymerised from
hydroxyacetic acid.11 Dexon II® has a polycaprolate coating to
improve handling characteristics. Polyglycolic acid (PGA) is ini-
tially stronger than surgical gut, but has less tensile strength than
the other synthetic absorbable sutures.10 PGA is absorbed by
hydrolysis and rapidly loses its tensile strength. Tissue reaction
from the absorption of this material is considerably less than
that encountered with surgical gut, and the by-products of
hydrolysis do not provide a growth medium for bacteria. 13,14
PGA has been reported to be unsuitable for use in the oral cav-
ity or in the presence of infected urine due to an alkaline pH,
which increases its rate of breakdown.15,16 PGA is suitable for
use in intestinal anastomosis, caesarean section, hernia repair
and any circumstance where extended approximation of tissues
under stress is not required. 17,18
Poliglecaprone 25 (Monocryl®)
Monocryl® is a monofilament absorbable suture made from a
co-polymer of glycolide and epsilon caprolactone. It is available
in either a dyed or an undyed form, both initially having greater
tensile strength than surgical gut.19 Monocryl is one of the
strongest absorbable suture materials available, although it
rapidly weakens after implantation in tissue.10 Nevertheless, the
strength remaining at 14 days is still greater than, or equal to,
that of plain or chromic gut. It is recommended for general soft
tissue approximation or ligation, and has been used for the clo-
sure of the linea alba in cats.19 Recommended uses include blad-
der surgery, subcutaneous closures and facial fractures in equine
surgery, although the results have not been evaluated.20
Poliglecaprone elicits minimal tissue reaction and has good knot
security and handling characteristics.21
Polydioxanone (PDS II®)
PDS II® is a synthetic monofilament absorbable suture made
from a polymer of paradioxanone. It has greater initial tensile
strength than surgical gut, PGA or polyglactin 910, but has the
poorest knot security of the synthetic absorbables.10 The advan-
tage of PDS II® is its strength retention after implantation and
ease of passage through tissues.21 It is useful wherever prolonged
approximation of tissue under stress (up to 6 weeks) is desirable
and can be utilised in a wide variety of tissues.16 PDS II® can be
used in the bladder in the presence of sterile and infected canine
urine.16 Absorption of PDS II® is essentially complete at 6
months.
Polyglyconate (Maxon®)
Polyglyconate is a monofilament absorbable suture with prop-
erties similar to PDS. Its effective strength after implantation is
superior to that of all other absorbable materials.10 Absorption
is by hydrolysis, with initial losses in tensile strength before
reduction in mass. This process is completed approximately 6
months after implantation. It has better handling characteristics
than polyglactin 910 and polypropylene, with better knot per-
formance than polydioxanone.20 Polyglyconate has been
reported to be superior to nylon and polybutester for tendon
repair,22 and has been recommended for a wide variety of uses
in veterinary surgery. It has, however, been shown to have less
longevity in canine urine in comparison to polydioxanone and
chromic gut.16
142
Poly L-lactide/glycolide (Panacryl® )
Panacryl® is a synthetic, braided, undyed absorbable material
composed of a co-polymer of glycolide and lactide
(www.ethiconinc.com). It is coated with a co-polymer of capro-
lactone and glycolide, with absorption by hydrolysis. There is
sparse available literature regarding this suture material, which
was developed to provide increased tensile strength, good knot
security and extended absorption times, with minimal foreign
body reaction. Ethicon Incorporated has discontinued its pro-
duction due to insufficient sales (Media Press Release, July,
2002).
Non-absorbable suture materials
Silk (Mersilk®, Perma-Hand®)
Silk is a nonabsorbable suture made from the cocoon of the
silk worm. It elicits an intense tissue inflammatory reaction and
has significant capillarity. Available coated forms reduce capil-
larity at the expense of knot security.3 There is higher initial ten-
sile strength than surgical gut, with retention of 50% of its ini-
tial strength at 1 year.11 Complete absorption may occur at a
period of greater than 2 years.23 It may cause ulceration when
used in hollow viscera, such as the gastrointestinal tract, or pre-
dispose to calculi formation in the urinary or biliary tract.1 Silk
has superb handling characteristics and is the benchmark for
handling characteristics in other suture materials.
Polybutester (Novafil®)
Polybutester is formed from a monofilament copolymer of
polybutylene and polytetramethylene, which elicits minimal tis-
sue reaction. It displays good handling characteristics and knot
security, with retention of strength and integrity regardless of
knotting method.24 Polybutester suture materials are suitable for
use in situations where prolonged wound healing is antici-
pated.22 It also may be suitable for repair of tissues such as ten-
dons, where its elastic properties may be an advantage, especially
in the early stages of healing.22
Polyester (Mersilene®, Ethibond®, Surgidac®)
Polyester is a nonabsorbable multifilament suture material
made from polyethylene terephthalate. Polyester suture materi-
als are stronger than either silk or surgical gut,10 although they
have poor knot security and elicit a greater tissue reaction than
the other synthetic non-absorbable suture materials.13 This is
particularly true of the coated forms, with five square knots
being recommended for knot security.24 Ethibond® suture
material has a polybutylate coating, which improves the han-
dling characteristics and reduces the high tissue drag encoun-
tered with the uncoated forms. Polyester suture materials should
not be used in infected wounds, where bacteria may become
trapped between the fibres and isolated from phagocytic cells,
resulting in persistent incisional drainage.4 Polyester sutures
have been shown to have no significant loss of tensile strength
over time. The use of size 3 polyester has been reported in
equine laryngoplasty.4
Nylon (Ethilon®, Monosof®, Nurolon®, Surgilon®, Supramid®)
Nylon is an amine-containing thermoplastic derived from
hexamethylenediamine and adipic acid.6 It is available as either
monofilament (Ethilon®, Monosof®) or multifilament
(Nurolon®, Surgilon®, Bralon®, Supramid®). Although classed
as a non-absorbable material, up to 30% of the initial tensile
strength is lost 2 years post implantation.11 Nylon has been
Aust Vet J Vol 81, No 3, March 2003

shown to maintain a high level of elasticity after implantation in
tissue, an important consideration in circumstances where tissue
oedema and inflammation may develop. This makes nylon use-
ful as a skin suture.25 The main disadvantages of nylon are its
poor handling characteristics and knot security.23 Multifilament
forms have improved handling and knot security at the expense
of increased capillarity.13
Supramid® is a twisted multifilament, polymerised caprolac-
tam. It is enclosed in a smooth sheath of proteinaceous mater-
ial, has superior tensile strength compared with other nylon
materials, but poor knot security.6 It is available to veterinary
practitioners, but only in large diameters.
Polypropylene (Prolene®, Surgilene®)
Polypropylene suture materials are a monofilament made
from a stereoisomer of polypropylene. Polypropylene has the
greatest strength of the synthetic non-absorbable materials with
no appreciable strength reduction after implantation.10,11 It is
the least thrombogenic suture material, and frequently used in
vascular surgery.26 The elastic properties and longevity of
polypropylene make it suitable for use in the skin.5 The disad-
vantages of the material are poor knot security and high mem-
ory.13
Stainless steel
Stainless steel is an alloy of chromium, nickel and molybde-
num, available as either monofilament or multifilament suture.
It is biologically inert and the strongest of all suture materials.13
The most common use is in orthopaedic surgery, but it may be
useful for tendon or ligament repair, and in contaminated or
infected wounds such as repair of ventral abdominal wall hernias
secondary to infection in horses.14,27-29 Stainless steel sutures
have a tendency to cut through tissue and have poor handling
characteristics.23 Movement of tissue over buried knot ends may
cause tissue necrosis.11
Needle selection
An appropriate needle is chosen based upon tissue type, loca-
tion, accessibility of tissue and size of suture material. The nee-
dle should be of the smallest size to penetrate the tissue, yet long
enough to penetrate both sides.1 Swaged on needles are available
with pre-packaged lengths of suture material. Their advantage
lies in reduced tissue trauma, convenience, ease of handling and
sharpness.1,13
Taper point needles are used on non-fibrous soft tissues, such
as abdominal viscera, to minimise the risk of trauma to adjacent
tissues.1 With increasing density of tissue, taper cut and reverse
cutting needles may be required to penetrate tissue without
excessive trauma.1 Penetration of dense tissues such as fascia and
skin requires cutting needles.1
Knots and ligatures
The knot is the weakest part of the suture.13 In general, square
knots are used because they are the most secure.1,8 When the
first throw of a square knot does not maintain apposition, a sur-
geon’s knot may be used.1 This will, however, place more suture
material into the wound. The minimum number of throws for
each knot is dependant on the suture material characteristics.
Tissue adhesives
There is a variety of tissue adhesives that may be used for
haemostasis during surgery on parenchymatous organs, on
corneal lacerations and to close skin incisions.13 The most com-
Aust Vet J Vol 81, No 3, March 2003
Clinical
mon tissue adhesives are cyanoacrylates. Toxicity is a problem
with some adhesives, especially propyl and methyl cyanoacry-
lates, so the less toxic n-butyl or isobutyl-2 cyanoacrylates are
preferred.30 Their use is contra-indicated in the presence of
infection or gangrene, on excessively moist surfaces and in situ-
ations where they may interfere with normal cortical fracture
healing.6
Tissue staples
Stapling of skin or tissues in procedures such as gastrointesti-
nal surgery, liver and lung resection, provides a quick and effec-
tive alternative to manual suturing.31 Skin staplers place indi-
vidual rectangular shaped sutures in a single row, but staplers
used on other tissues place a double row of staples in a staggered
‘B’ configuration.13 Tissue staples allow rapid closure, decrease
contamination and preserve blood supply.6 They may be inef-
fective if applied to tissue of excessive thickness and may provide
ineffective haemostasis of large blood vessels.30 Stainless steel
staples have been shown to be a quick and economic way to
close large skin incisions,32 and a safe and efficient means of
small intestinal anastomosis.33
General recommendations on suture material usage
Skin
Skin has a longer healing time when compared to viscera,23 so
monofilament nonabsorbable suture materials, such as
polypropylene or nylon, are preferred for closure.6 Furthermore,
the stress strain curves of these sutures are similar to those for
skin. Alternatively, stainless steel staples can be used for the clo-
sure of large incisions to increase speed and ease of application.32
In small animals, 4-0 to 2-0 polypropylene or nylon are suit-
able.10 In large animals routine skin closure is achieved with a
synthetic nonabsorbable suture such as polypropylene in sizes 2-0
to 2 depending on the degree of tension across the wound.4
Fascia
Small animals — The use of a simple continuous pattern to
close the abdomen is widely recognised as safe and acceptable
practice.8 Synthetic absorbable suture materials are preferred for
this purpose because of their prolonged retention of tensile
strength and reduced tissue response.9,10,13 Suitable suture mate-
rials for fascial closure include PDS, polyglyconate, PGA,
polyglactin 910 and polypropylene. Suture size is based on
patient size. Generally size 3-0 is suitable for small dogs and cats,
2-0 for medium sized dogs, and 0 for large dogs.10,23
Large animals — A wide range of suture materials and pat-
terns has been used to close ventral midline incisions.
Continuous patterns are commonly employed, with the advan-
tages of more even distribution of tension along the length of
the incision, fewer knots and less suture material.34 Equally valid
are interrupted suture patterns such as cruciate and simple inter-
rupted.4 Use of surgical gut is not recommended due to a higher
incidence of incisional herniation.33 Use of size 3 polyglactin
910 has been recommended,12 whilst some authors suggest the
use of an absorbable monofilament, such as double size 2 polyg-
lyconate.20 Both are amongst the strongest of the synthetic
suture materials.12 Non absorbable suture materials, such as
polypropylene, are not recommended because of the incidence
of sinus tract formation with their use.35-37 Stainless steel sutures
have been used in large animals for surgical wounds that have
dehisced following closure with other materials.29
143
Clinical
Enterotomy
Small animals — Common indications for enterotomies in
small animals are to remove intraluminal foreign bodies or to
perform full thickness biopsies.38 The current recommendation
for enterotomy closure in small animals is with a synthetic
absorbable suture material. Suitable materials include polygly-
colic acid, polyglactin 910 and polydioxanone. Sizes 4-0 or 3-0
with small swaged-on taper point, taper cut or reverse cutting
needles are suitable in these situations, depending on the thick-
ness of the intestinal wall. Chromic gut is unsuitable due to the
potential for rapid absorption in the presence of collagenases.17
Large animals: Pelvic flexure enterotomies in horses are under-
taken to remove ingesta, intraluminal foreign bodies,
impactions and enteroliths, and to assist in manipulation of the
colon during abdominal surgery.39 Closure is achieved in two
layers, with a simple continuous pattern including the mucosa,
submucosa and seromuscular layers, oversewn with a continu-
ous inverting pattern.12 Both 2-0 polyglactin 910 and 2-0 sur-
gical gut have been used.40 The advantages of polyglactin 910
are a decrease in tissue reaction around the suture site and a pre-
dictable absorption pattern.
Intestinal anastomosis
Small animals: Common reasons for resection and anastomo-
sis of intestine are neoplasia or devitalisation, caused by stran-
gulation or infarction. The simplest method is an end-to-end
anastomosis. There are four techniques in common use: invert-
ing, everting, invaginating and approximating patterns.41
Absorbable mono or multifilament material should be used. Size
3-0 or 4-0 suture materials with small diameter swaged on taper
point, taper cut or reverse cutting needles are ideal depending
on the thickness of the intestine. Polydioxanone, polyglyconate,
polyglycolic acid and polyglactin 910 are suitable for this pur-
pose, although the multifilament sutures may have slightly more
tissue drag.38 Skin staples are a useful alternative to manual
suturing in small intestinal anastomosis, with no decrease in
bursting strength, bowel diameter or healing when compared to
hand sewn anastomosis.33
Large animals: A number of suture patterns have been
described for intestinal anastomosis, but the modified Gambee,
crushing and two layer inverting pattern are thought to be supe-
rior.42 Either polyglactin 910 or polydioxanone is recom-
mended.43 Surgical gut is not advisable due to the increased tis-
sue reaction and the presence of proteolytic enzymes.42 In
horses, the two layer inverting pattern has been shown to be
superior to single layer techniques, due to reduced incidence of
adhesion formation and maintenance of lumenal diameter. It
consists of a full-thickness simple continuous pattern, inter-
rupted one-half or one third the way around the intestine, using
size 2-0 material on a taper point needle oversewn by size 2-0 to
0 material in an inverting pattern.44 Stapling devices can provide
a quick and effective alternative to manual suturing if used
properly, with a reduction in surgery time, tissue manipulation
and peritoneal contamination.31
Urinary tract
The bladder is one of the weakest tissues in the body, however
it regains its original strength within 14 to 21 days.16
Absorbable suture materials are considered ideal for use within
the urinary tract, whilst non-absorbable suture materials are
more likely to act as a nidus for calculi formation.45 Exposure of
absorbable suture materials to urine may hasten the loss of ten-
144
sile strength through increased hydrolysis.45 Both braided and
monofilament absorbable sutures have been suggested for use in
the urinary tract. The advantages of monofilament sutures, such
as polydioxanone, polyglyconate or polyglecaprone 25, in the
urinary tract include a reduced adherence of bacteria on the
suture surface, decreased tissue drag and greater strength at
smaller sizes.46 The advantage of the multifilament absorbable
materials, such as polyglactin 910 or polyglycolic acid, is their
faster absorption time in these tissues.
Small animals — Voiding pressure in small animals may reach
between 20 and 40 mm Hg. Size 7-0 chromic gut has been
shown to withstand bursting pressures of up to 550 mm Hg in
the bladders of rats.47 It is suggested that either 5-0 or 4-0 syn-
thetic absorbable sutures, reportedly polyglycolic acid and
polyglactin 910, be used.
Large Animals —Increase in size results in a increase in void-
ing pressure in large animals. Pressures of up to 90mm Hg may
be reached in ponies and mares.48 Size 2-0 or 1-0 suture mate-
rials are recommended, using polyglactin 910 or polyglycolic
acid.45
Caesarean section
Small Animals —Uterine closure is usually achieved with a full
thickness simple continuous pattern in the first layer, oversewn
with a continuous Cushing pattern using 3-0 to 4-0 suture
material, with a swaged on small taper point needle. 49
Polydioxanone or polyglyconate has been used.50
Large animals: Surgical gut, polyglactin 910 and polypropy-
lene have been used for uterine closure in horses.51 A two layer
closure using size 0, 1, or 2, synthetic absorbable suture mater-
ial can be used.52,53 A simple continuous, Cushing or Lembert
pattern has been described, which is oversewn with a Cushing,
Lembert or Utrecht pattern.54,55 In cattle, size 2 or 3 surgical gut
is commonly used,56 in a single layer Lembert or Utrecht pat-
tern.57 The use of size 0 to 2 polyglycolic acid and polyglactin
910 has also been recommended.58
Vascular anastomosis and ligation
Small animals — Monofilament polypropylene is the most
commonly used material for vascular anastomoses. Strength,
smooth texture and an inert nature make it an excellent choice
for vascular surgery. Size 5-0, 6-0 or 7-0 suture materials with
swaged on needles are appropriate, although aortic grafts in
large dogs may require a 4-0 suture.26 Use of an absorbable
mono-filament or multi-filament, either 3-0 or 4-0 for small
vessels and 2-0 to 1 for larger vessels, is appropriate for vessel lig-
ation.10
Large Animals —In large animals, polypropylene is also rec-
ommended for vascular anastomoses. Suture size ranges from 6-
0 to 5-0, depending on vessel diameter and type1. For haemosta-
sis, a size 3-0 absorbable suture material such as polydioxanone
or surgical gut is usually adequate.4 Larger vessels or arteries may
require a transfixation ligature applied proximal to the circum-
ferential ligature to achieve reliable haemostasis.
Conclusion
A large selection of suture materials is available for veterinary
use. Suture cassettes are commonly available and relatively inex-
pensive, but there is limited material selection, they have
reduced efficiency and require the use of eyed needles. By
reviewing each material and its relevance to a specific scenario,
the veterinarian can maximise the support of healing tissues.
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(Accepted for publication 24 January 2003)

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