SUTURE MATERIALS
What is Suture?
Suture is a stich or series of stiches made to secure apposition of the edges of a surgical or
traumatic wound.
What is suture materials?
Suture materials is an artificial fibers used to keep wound together until they hold themselves by
natural which is synthesized & oven into a stronger scar.
Ideal Suture material
o Remain intact until union occurs.
o Cause minimum tissue reaction.
o Be non-capillary, nonallergic, noncarcinogenic, nontoxic (Capillarity is the process by
which fluid and bacteria are carried into the interstices of multifilament fibers)
o Be of uniform thickness.
o Be knot able.
o Have smooth surface.
o Have sufficient tensile and functional strength.
o Easily sterilizable.
o Cheap and readily available
o Easy to handle.
Classification of suture material
According to source:
1. Natural
2. Synthetic
3. Metallic
According to structure:
1. Monofilament
2. Multifilament
According to fate:
1. Absorbable
2. Non absorbable
According to coating:
1. Coated
2. Uncoated
Monofilament vs multifilament
Monofilament Multifilament
Has no capillary action Has capillary action
Less infection risk Increased infection risk
Smooth tissue passage Less smooth passage
Higher tensile strength Less tensile strength
More throws required Better knot security
Absorbable Nonabsorbable
Degraded by enzymes, hydrolysis or phagocytosis Encapsulated or walled off by fibrosis
Used to hold the edges in approximation Used to suture at sites where tensile
temporarily until the wound is heal strength need to be maintained
Biological response to suture materials
Natural absorbable- Synthetic absorbable- Non-absorbable-
Proteolytic degradation. Hydrolysis. Encapsulation.
Intense tissue response. Less intense response. Acellular response.
ABSORBABLE
Absorbable sutures are those which get absorbed by the tissues after a variable period of time.
The absorption takes place by phagocytosis and enzymatic action.
1. NATURAL ABSORBABLE
Catgut (surgical gut).
The word catgut is derived from the term kitgut or kitstring (the string used on a kit, or fiddle).
Misinterpretation of the word kit as referring to a young cat led to the use of the term catgut.
Surgical gut actually is made from the submucosa of sheep intestine or the serosa of bovine.
intestine and is approximately 90% collagen. It is broken down by phagocytosis and, compared with
other suture materials, elicits a notable inflammatory reaction.
Plain surgical gut loses strength rapidly after tissue implantation.“Tanning” (cross-linking of
collagen fibers), which occurs by exposure to chrome or aldehyde, slows absorption. Surgical gut is
available as plain, medium chromic, or chromic; increased tanning generally implies prolonged
strength and reduced tissue reaction. Surgical gut is rapidly removed from infected sites or areas
where it is exposed to digestive enzymes and is quickly degraded in catabolic patients. The knots
may loosen when wet.
Type Degree of chromicising Approximate number of days
taken for absorption
Type-A Plain 10 days
Type-B Mild chromic 15 days
Type-C Medium Chromic 20 days
Type-D Extra chromic 40 days
Depending on the preservative used catgut is available as either boilable or non-boilable catgut.
1. Boilable catgut is preserved in Xylol or in solution of Toluene 99.75% plus phenyl mercuric
acetate 0.025%. These tubes can be sterilized by boiling autoclaving etc. Boilable catgut is
somewhat stiff. To soften it, it is to be soaked in sterile water or normal saline before use.
2. Non boilable catgut is supplied in tubes containing 90 to 95% alcohol and so it cannot be
sterilized by boiling. Alcohol is preservative for catgut but when in lower concentration of
alcohol, the strength is reduced because of proportionately higher water content. The minimum
concentration of alcohol recommended for the purpose of preserving catgut is 85%.
Catgut is available in different thickness as follows:
0000000 or 7/0, 6/0, 5/0 --------------------0,1, 2, 3, 4, 5, 6, 7
Size 2/0 or 1/0 are available for sutures on peritoneum and bowel well in small animals surgery
and for ligating vessels etc. Size no. 1 and 2 are commonly used for sutures of muscles, fascia
etc. for small animals’ surgery.
In large animal surgery, no. 3 for muscle, 5, for rumen, abdomen etc.
Absorption: By phagocytosis. The absorption of catgut depends on many factors-
The absorption is relatively low in muscle and rapid in mucous membrane (stomach, cervix,
vagina where proteolytic enzymes are profound).
It is quicker in animals having protein deficiency.
In the presence of infection and suppuration as well as in individuals who are hypersensitive to
catgut, the absorption is very fast. Complete mass absorption in approximately 90 days.
Approximately 50% of tensile strength remain after 14 days.
2. Kangaroo tendon. This is another absorbable suture material prepared out of the tendons
taken from the tail of kangaroo. Being very strong, kangaroo tendons are useful for suturing
joint capsules, hernial openings etc.
3. Fascia lata. An absorbable suture material made out of fascia lata of the bovine. Available in
tape-like pieces it is preserved like catgut in glass tubes. This is only rarely used. These pieces
are transferred into glass tubes containing physiologic saline solution, incorporated with
penicillin and streptomycin. Stored in refrigerator at -10°F. When needed for use the tube is
broken and the facia is put in sterile physiological saline at room temperature.
4. Cargile membrane. This is a thin sheet of tissue made out of bovine caecum used to cover
surfaces from which peritoneum has been removed. Not in general use.
5. Amniotic membrane: It is prepared from amniotic membrane of fetuses.
6. Collagen: It is prepared from bovine flexor tendon filament.
2. SYNTHETIC ABSORBABLE
Synthetic absorbable materials (e.g., polyglycolic acid, polyglactin 910, polydioxanone,
polyglyconate generally are broken down by hydrolysis.
POLYGLYCOLIC ACID (PGA)
Type: Braided and coated multifilament
Composition: Polyglycolic acid
Coating: Polycaprolactone and calcium stearate (1%)
Colour: Violet
Tissue reaction: Minimal
Absorption: The hydrolytic action by which the material is broken down results in total
absorption in approximately 60 to 90 days. Approximately 50% of tensile strength remain after
21 days.
POLYGLECAPRONE 25 (Monofast)
Type: Monofilament
Composition: Polyglecaprone 25, a copolymer made of 75% glycolide and 25% Є-caprolactone
Coating: None
Colour: Violet
Tissue reaction: Minimal
Absorption: The hydrolytic action by which the material is broken down results in total
absorption in approximately 90 to 120 days. Approximately 60% of tensile strength remain
after 7 days.
POLYGLACTIN 910 (Vicryl, Acryl etc.)
Type: Braided and coated multifilament
Composition: Polyglactine 910, a copolymer made of 90% glycolide and 10%L-lactide
Coating: Poly-glycolide-co-L-lactide and calcium stearate (<1%)
Colour: Violet
Tissue reaction: Minimal
Absorption: The hydrolytic action by which the material is broken down results in total
absorption between 56 and 70 days. Between 40% and 50% of tensile strength remain after 21
days.
Disadvantage:
1. In case of prolong approximation can’t be used.
2. Delayed absorption & increased infalmmation.
POLYDIOXANONE
Type: Monofilament
Composition: Polydioxanone, a polymer made from polyester poly (p-dioxanone)
Coating: None
Colour: Violet
Tissue reaction: Minimal
Absorption: The hydrolytic action by which the material is broken down results in total
absorption in approximately 180 to 210 days. Approximately 50% of tensile strength remain
after 42 days.
NON-ABSORBABLB SUTURE:
These sutures do not get absorbed by the tissues. When used as outside sutures they are removed
after healing is completed. If allowed to remain in tissues they get encapsulated by connective
tissue.
1. Silk. This is a non-absorbable suture commonly used. It is cheap, easily available, easy to
handle, easily sterilised by boiling and is well-tolerated by tissues. Silk is available in size
numbers 0 to 14. A disadvantage of silk is that it is capillary.
2. Silk worm gut. This is prepared out of the silk sacs of the silkworm. non-capillary and
useful for cutaneous sutures.
3. Cotton. This is very cheap suture material. It can be sterilised by boiling. It is less irritating
to tissues than silk or catgut. But high capillary action is a disadvantage. They spread
infection in wound when applied to skin and luminal surfaces.
4. Linen. This is made out of superior quality cotton. It has good tensile strength. It is capillary
in nature and produces more tissue reaction than cotton and silk.
5. Nylon. This is a synthetic product. It is non-capillary, strong, and has a smooth surface. It is
somewhat stiff and therefore a little difficult to handle and to put secure knots. While using
nylon, special knots called “nylon knots” should be put since ordinary surgical knots of nylon
become loose very easily.
6. Horse hair. It is cheap, non-capillary, flexible and is easily sterilized. It causes little tissue
reaction.
7. Umbilical tape. Umbilical tape: used to tie the umbilical cord of the new born or as vulvar
suture in cases of prolapse of vagina of uterus.
8. Dermal suture. This is a non-absorbable suture used for skin suture. It is silk coated with
tanned gelatin or other protein substance. The protein coating prevents ingrowth of granulation
tissue into the suture material and also makes it non-capillary. It is not available.
10. Vetafil. This is a non-absorbable suture made out of a synthetic fibre. It is a patent product. It
is non-irritant, non-capillary and easy to handle. Sizes commonly used are medium (diameter 0.2
mm) heavy (0.3 mm), extra heavy (0.4 mm) and special (1.1 mm).
11. Prolene. Good synthetic material. non-irritable.
METALLIC NONABSORBABLE SUTURE
12. Stainless steel wire. S.S wires of different sizes are used for suturing. They are very strong
and are chemically inert. They do not lose strength by wetting and are easily sterilised by boiling,
autoclaving, etc. Also they are non-capillary and non-irritant. Its disadvantages are: 1) Being
stiff, difficult to handle; 2) May cut through tissues; 3) Knots are insecure unless carefully
placed; 4) Sharp ends may prick through tissues; 5) Continuous sutures may break into fragments
when subjected to constant movement and therefore it is better to put interrupted suture only.
13. Wires of tantallum, silver etc., are similar to stainless steel wires, but are costlier.
14. Aluminium wire. It is more flexible than stainless steel.
15. Wound clips. Michel wound clips are sometimes used for skin sutures. The clips are made of
a malleable metal. They are applied with special forceps and compared to sutures can be applied
far more quickly. They do not enter into the wound and do not leave recognisable scars. But they
are not strong enough to hold wound edges under tension and can be easily removed by the
patient.
16. Pin sutures. Ordinary pins can be used for keeping skin edges together.
Miscellaneous:
Tissue adhesive
