SUTURE MATERIALS

drh. Analis Wisnu Wardhana, M.Biomed

 The ideal suture materials
1. Non reactive in the tissue
2. Easy to handle
3. Monofilament composition
4. Easy to completely sterilize
5. Have high tensile strength in small size
6. It should maintain a knot without slippage
7. Absorb in predictible manner (30-60 days)
8. Be economical
 Since the ideal suture material does not
exist, the surgeon must choose materials
based on a knowledge of attributes of those
materials an the condition of wound
Ex:
if biological processes reduce the suture
strength (as occurs with catgut in purulent
wound), the suture size must be increased
or another suture material must be chosen
Polyglycolic acid, polypropylene, or
polyethylene may be preffered in
subcutaneous tissue because of the minimal
tissue response and swelling that result
ABSORBABLE SUTURE
Are digested and assimilated by body
during and after healing and my be of
animal or synthetic origin.
Are degraded primarily by macrophages
as healing progresses
A. Surgical Gut
Derived from submucosal layer of sheep
or the sorosa of cattle intestines, which
is harvested, purified and sterilized
Its classified by its degree of
chromatization or tanning (treated with
chromic acid to lengthen and standarize
absorbtion time and to reduce the
intensity of soft tissue reaction to the
gut)
 4 types of surgical gut:
1. Type A plain or untreated (absorbed within 3 7 days)
2. Type B Mild chromic treatment (absorbed within 14
days)
3. Type C Medium chromic treatment (absorbed within 20
days)
4. Type D Extra chromic treatment (absorbed within 40
days)

Surgical gut is available in USP size 3 (the haviest), to 7-0

(the thinnest)
Not to submerged for long period, because of hydroscopic
Three or more throws should be used in tying.
Capillary and support infection
Used for general ligation and for surgery of the
gastrointestinal, urogenital and parenchymatous organs
Contra indicated for skin suture and implantation against
nervous tissue
B. Collagen
Are prepared from bovine tendon as
homogenous extrusion of collagen fibers
Uniform size
Ties well
Handles as well as catgut
Cause less inflamatory than gut
Prematurely absorbed and may loose
strength in vivo
C. Polyglycolic acid (PGA)
Woven from fine filementous threads
extracted from hydroacetic acid
Suture size is determine by the number of
woven strands
Handle well, but the knot tend to slip
High coefficient of friction and tens to cut
friable tissue
Uniformly absorbed in 40-60 days
Less reactive than surgical gut with similar
indication
Dont use in tissue that heal slowly or in
mucosa of urinary bladder or urethra
(prematurely absorbed in urine)
D. Polyglactic acid (PLA)
Synthetic absorbable suture that is
copolymer of lactide and gycolide
Similar use and attributes to PGA exept
that may be braided or monofilament
Maintain tensile strength for about 3
weeks and is absorbed within 90 days by
hydrolisis
E. Polydioxanone (PDS)
Synthetic monofilament absorbable suture
Less drag in tissue and may be used more
effestively in friable tissues
Safe in use in urologic surgery

Other absorbable suture materials

Kangaroo tendon (tail ), fascia lata and
dura
NON ABSORBABLE SUTURE
Nonabsorbable suture are neither
absorbed nor digested by the tissue, but
many types fragment in time
High tensile strength and produce
minimal tissue reaction
Difficult to handle and are subject to
slippage knots
 Grouped into:
Mtals, natural fibers and synthetics
Divided by USP into:
1. Class I (silk or synthetic fiber suture that
either has been twisted or braided or
monofilament)
2. Class II (composed of cotton or linen
fibers or coated natural or synthetic
fibers in which the coating adds
thickness but not appreciable strength
3. Class III composed of monofilament or
multifilament metal wire
A. Metals
Gold, silver, Copper, bronze, and tatalum (-)
Stainless steel
High tensile strength of both monofilament or
multifilament
Easy sterilized
Inexpensif
Difficult to handling, lack elasticity, difficult to knot
Monofilament steel satisfatory for use in infected
wounds but not multifilament
Appropriate for general clossure, retension
sutures, skin closure and tendon repair
Metal clips an staples
Silver and stainless steel clips are used to
ligate small vessels, approximate wound
edges, secure accessory drapes to the
edges of wounds
Easy to apply and sterilize
Tends to increase scarring in tissue
B. Sutures of natural origin
Silk
Widely used nonabsorbable suture materials
Inexpensive, universally available, readily sterilized
Should not be used in infected wounds
Used in cardiovasculer, opthalmic, and gastrointestinal
surgery

Dermal suture
Is twisted silk fibers encased in a nonabsorbing
coating of protein, such as gelatin to prevents in
growth tissue cells and facilitates removal after skin
closure
Use primarily in plastic surgery
Virgin silk
Is made from several natural silk fibers twisted to form a single
strand of small diameter
Closely apllied with carefully handling and form small knots
Cotton
Made from cotton fibers that are twisted into a strand
Weakest of natural sutures, gain strength tensile when wet (should
moistened)
Well tolerate by tissue
Easy to use
Easy sterilized
Knot well
Capillary may contribute to the formation of sinuses and pustules
Stick to wet surgical gloves
Linen
Twisted from long strands of flax
Lower tensile strength
Rarely used
C. Sutures of synthetic origin
Monofilament form (little tissue reaction)
Noncapilary and have high tensile strength
Have degree of plasticity (compensate tissue swelling)

Nylon
Produced minimal tissue reaction
High tensile strength
Used in skin suture
4 or more throws are needed for knot stability
Polymerazed caprolactum
Twisted synthetic fiber suture with a smooyh coating
High tensile strength and cause little tissue reaction
Partially set by steam sterilization
Handling more difficult
Polyester fiber
Greater strength, lesss tissue reaction
Tend to saw or tear tissues, an hold knots poorly
Suitable for skin and cardiovascular surgery
Polyethylene and polypropylene
More easily handled and knotted
Essentially inert in tissues and retain high tensile
strength
Multiple throws recommended for knot security
CLINICAL USE OF SUTURE
MATERIALS
Physical characteristic
Durability
- fascia (2-0 or 0), large animal (0 to 2)
- ligation of large vessels (0 to 2-0)
- dense connective tissue (0 to 3-0) small animal, 0 to 2
in large animals
- skin and subcutaneous tissue (0 to 4-0)
- thin skin, skin grafts, small vessels (3-0 to 4-0)
- gastrointestinal and urogenital surgery (3-0 to 4-0)
- vascular sutures (3-0 to 6-0)
- nerve sheats (5-0 to 6-0)
 Handling and Knot security
- the strongest sutures have the poorest
knotting quality
- autoclaving is safe, if done no more than
three times on: nylon, polyester,
polypropylene and stainless steel
- sterilization with ethylene oxide is safe
for all sutures if sufficient aeration
time is permitted after sterilization
Biologycal characteristic
All sutures produce tissue reaction that lasts at least 5
days, after 7 days the reaction to nonabsobable sutures
becomes minimal
Absorbable sutures behave as nonabsorbable sutures
until absobtion begin
Polyglyconic acid and polydioxanone are better than
surgical gut in reducing the incidence of wound infection
Sutures placed near nerves should produce as little
inflamation as possible
Vascular surgery ; silk, coated nylon, polypropylene
Hollow organs: chromic catgut, polydioxanone,
polyglactic acid
Urinary tract: nonabsorbable sutures
Gastrointestinal: chromic catgut, polypropylene,
monofilament nylon
 Fascia and tendons: stainless steel, nylon,
polypropylene
Skin: noncapillary sutures
SUTURE NEEDLE
Rigid
Flexible
Sharp
Clean and corrossion resistant
Smooth coated
Type of needle eyes
 Body or shaft of suture needles varies in
wide range of: gauge, length, shape
And may be: round, oval, flat, angular,
ribbed
Needle shape size
 Curved- deep tissue
Straught/half curved superficial tissue
Needle points generally classified as:
-taper (cutting)
-blunt (noncutting)(suturing liver or kidney)
Cutting point:
- triangular cutting
- reverse cutting
- side cutting
- flat spatula
- modified spatula