Suture

The word "suture" describes any

strand of material used to ligate
(tie) blood vessels or approximate
(sew) tissues.
History
Inthe10th century AD
ABUL QASIM AL ZAHRAVI in Baghdad
successfully Performed Thyroid Surgery
with the help of sutures.
Ideal Suture
Sterile

Easy to handle
Minimal tissue reaction/trauma

High tensile strength retention

Knot security

Absorbable

Useful in all tissues

Suture Classification
Absorbable / Nonabsorbable
Natural / Synthetic
Braided / Monofilament
Absorbable Sutures
Definition- sutures that can be absorbed into the
body by either enzymatic or hydrolitic processes.
Properties
- Absorption Rate- Length of time required for a
suture to be absorbed into the tissue.

- Tensile Strength in Vivo- Amount of tension or pull

expressed in pounds which a suture will withstand
before it breaks inside the tissue.
Nonabsorbable
Definition - Sutures that are not absorbed
into the body.
Properties
- Encapsulate - enclosed by a protective
coating or membrane
- Reactivity - tissue response to a foreign
material.
Natural
Definition - Sutures made of material that
can be found in nature.
Properties
- Reactivity
Absorption method
- Enzymatic- Chemical process of
decomposition involving the breakdown of a
substance by the body's enzymes
Synthetic
Definition - Sutures made from materials
created by man.
Properties

- Reactivity
Absorption method

- Hydrolysis - Chemical process of

decomposition involving the breakdown of a
substance by the presence of water or
moisture.
Monofilament

Definition- A single strand of material

Properties
- Less traumatic
- Resist Bacterial harboring
Braided
Definition- Multifilament sutures that consist
of several filaments or strands, twisted or
braided together.
Properties
- Greater tensile strength
- Pliability and flexibility
Suture Selection
Variety of Size
Balance of tissue
reaction and suture size
Example Suture Selection
Absorbable Non Absorbable
Natural Natural
Fast Absorbing Gut Silk
Plain Gut Stainless steel
Chromic gut Synthetic
Synthetic Ethilon*
(nylon) suture
VICRYLRapide* NOROLON*
(polyglactin 910) suture
(nylon) suture
VICRYL* MERSILENE*
( polyglacin 910) suture
(polyester) suture
MONOCRYL* ETHIBOND*
(polyglecaprone 25) suture
(polyester) suture
PDS II* PROLENE*
(polydioxanone) suture
(polypropylene) suture
Example Suture Selection
Absorbable
Natural

Fast Absorbing Gut Plain Gut Chromic Gut

Fast Absorbing Gut Natural Absorbable
Monofilament
(Collagen) suture

Submucosal or serosal layer of animal

intestine
97- 98% pure collagen
Clean and purified

Tensile Strength 7 days

Mass absorption 21-42 days
 Natural Absorbable
Plain Gut Monofilament

Submucosal or serosal layer of animal

intestine
97- 98% pure collagen
Cleaned and purified
Strands twisted for controlled diameter
Result is virtual nonofilament
Packed wet to keep supple

Tensile strength 7-10 days

Mass absorption 60-90 days
 Natural Absorbable
Chromic Monofilament

Submucosal or serosal layer of animal intestine

97-98% pure collagen
Cleaned & purified - high collagen purity
Strands twisted and dried
Polished for controlled diameter
Result is virtual monofilament
Packed wet to keep supple
Chromicizing process prolongs strength retention

Tensile strength 21-28 days

Mass absorption 90 days
 Natural Absorbable
Gut Sutures Monofilament

Advantages

ABSORBABLE - no foreign body left

MONOFILAMENT - ninimal tissue trauma
97-98% collagen - minimizes tissue
reactions
PACKED WET - pliable, good handling
& knotting
 Natural Absorbable
Chromic Gut Monofilament

Absorption is by enzymatic action

Absorption is unpredictable
Tissue reactions occur

Chromic Catgut at 14 days

Extensive tissue reaction with
acute inflammatory response.
Example suture selection
Absorbable
Synthetic

PDS II

VICRYL Rapide MONOCRYL

VICRYL
Coated

VICRYL RAPIDE* Synthetic

Absorbable Braided
(polyglactin 910) suture

Initial
strength equivalent to silk
Less reactive than other natural sutures

At 5 days, 50% strength remains

At 10 to 14 days, tensile strength is lost

Mass absorption 42 days

VICRYL* Synthetic
Absorbable Braided
(polyglactin 910) suture

Copolymer - POLYGLACTIN 910

Copolymer Coating - POLYGLACTIN 370
90% GLYCOLIDE
10% LACTIDE
7/0 & smaller 6/0 & larger
At 14 days 75% 75%
At 21 days 40% 50%

Mass absorption 56-70 days

VICRYL* Synthetic
Absorbable Braided
(polyglactin 910) suture

Advantages
SYNTHETIC Predictable absorption less tissue reaction

ABSORBABLE No foreign body left

COATING Easier passage through tissue

Minimal trauma in tissue
Knots slide easily
Coating is not removed in presence of fluids
VICRYL RAPIDE* Synthetic
Absorbable Braided
(polyglactin 910) suture

Advantages (con't)
BRAIDED Strong
Good handling and knotting
characteristics

For use in ophthalmic only

MONOFILAMENT Smooth passage through tissue
VICRYL RAPIDE* Synthetic
Absorbable Braided
(polyglactin 910) suture

TISSUE REACTIVITY COMPARISON

Coated VICRYL suture 2/0 at 14 days Chromic Catgut 14 days Extensive tissue
Minimal tissue reaction around suture reaction with acute inflammatory response
PDS* II Synthetic
Absorbable
(polydioxanone) suture
Monofilament

At 14 days 70% tensile strength remains

At 28 days 50% tensile strength remains

At 42 days 25% tensile strength is effectively lost

Mass absorption 6 months

PDS* II Synthetic
Absorbable
(polydioxanone)suture
Monofilament

Advantages

SYNTHETIC Predictable absorption

Less tissue reaction

MONOFILAMENT Smooth passage through tissue

Less bacterial harboring

POLYDIOXANONE Prolonged wound support

High initial strength
Good handling characteristics
Knot security
Example suture Selection
Nonabsorbable
Natural

Silk
Stainless steel
PERMA-HAND* SILK Natural
Nonabsorbable
Braided
Made from silkworm cocoons
Highest quality braided virgin silk
wax coated silk
Excellent handling & knot tying
charaacteristic
Standard for many years
Stainless Stell Natural Nonabsorbable
Monofilament
(stainless steel 316l) suture

Where extra strength is required

Sternum closure
Special packaging to minimize kinks
Pull out tendon sutures
Cardiac pacing wires
Example Suture Selection
Nonabsorbable
Synthetic

NUROLON ETHIBOND

ETHILON MERSILENE PROLENE

Nylon Suture
Considerations
Nylonabsorbs water
Degrades in vivo at approximately 15% to
20% per year
PROLENE* Synthetic
Nonabsorbable
(polypropylene) suture
Monofilament

Polypropylene offers lower coefficient of drag

Most inert material
Stretching and handling properties
Knot security
Used in vascular surgery
Skin & subcuticular layer
Prolene* Synthetic
Nonabsorbable
(Polypropylene) suture
Monofilament

Advantages

MONOFILAMENT Minimal tissue drag Easy to

remove after long-term
implantation

SYNTHETIC Minimal tissue reactions even in

the presence of infection

POLYPROPYLENE Will not fatigue with flexing Knots

lock easily Provides permanent
wound support.
PROLENE* Synthetic
Nonabsorbable
(polypropylene) suture
Monofilament

MINIMAL TISSUE REACTION

Enlarge photomicrograph PROLENE*

suture Implanted 6 months