Suture Materials

Introduction

Suture is a stitch or series of stitches that are made to secure the apposition of edges of surgical or traumatic wound (Wilkins). Suture material is any strand of material utilised to ligate blood vessels or approximate tissues (Silverstein L H).

Ideal suture material should have the following features.

Adequate tensile strength
Good knot holding property
Least reactive
Easy handling property
Less memory
Easily available and cost effective

Classification

According to fate:

Absorbable
Non absorbable

According to material:

Natural
Synthetic
Metallic

According to structure:

Monofilament
Multifilament

According to surface:

Coated
Uncoated

According to nature:

Braided
Twisted

Examples

Absorbable	Non absorbable
Degraded by enzymes, hydrolysis, or phagocytosis Used to hold edged un approximation temporarily until the wound is healed.	Encapsulated or walled off by fibrosis Used to suture at sites where tensile strength need to be maintained

Absorbable:

Plain catgut
Chromic catgut
Polyglactic acid (Vicryl)
Polyglycolic acid (Dexon)
Polyglyconate (Maxon)
PDS
Polyglecaprone (Monocryl)
Biosyn (Glycomer)

Uses:

Vicryl is used in bowel anastomosis like gastrojejunostomy, resection
In cholecystojejunostomy, choledonchojejunostomy, pancreaticojejunostomy
In suturing muscle, fascia, peritoneum, mucosa etc
In ligating pedicles, 1-0 chromic catgut or vicryl is used
In suturing tongue, inner aspect of lips, oral mucosa etc
In circumcision, 3-0 plain or chromic catgut is used

Non absorbable:

Silk
Polypropylene
Polyethylene
Cotton
Linen
Steel
Polyester
Polyamide (suttupack)
Nylon

Uses:

In herniorrhaphy
Closure of abdomen after laparotomy
For vascular anastomosis (6-0), nerve and tendon suturing
For tension suturing in Abdomen
For suturing skin

Natural:

Absorbable	Non absorbable
Catgut Chromic catgut Collagen Fascia Lata Beef tendon	Silk Silk worm gut Linen Cotton Ramie

Synthetic:

Absorbable	Non absorbable
Polyglycolic acid (dexon) Polygalactic acid Polyglactin (Vicryl) Polydioxane (PDS)	Nylon Polypropylene Polyesters Polyethylene

Metallic:

Stainless steel
Tantalum
Silver
Gold
Aluminium

Monofilament	Multifilament
No capillary action Less infection risk Smooth tissue passage Higher tensile strength More throws required	Capillary action Increased infection risk Less smooth passage Less tensile strength Better knot security

Monofilament:

Absorbable	Non absorbable
Catgut Chromic catgut PDS Polyglyconate Polyglecaprone (Monocryl) Biosyn (Glycomer)	Polypropylene Polyester Nylon Polyvinylidene fluoride PVDF

Multifilament:

Absorbable	Non absorbable
Vicryl Polyglycolic acid	Silk Cotton Linen

Coated:

Absorbable	Non absorbable
Catgut PDS Silk	Polyamide Polypropylene

Uncoated:

Cotton
Polyester

Braided:

Absorbable	Non absorbable
Polyglycolic acid Vicryl	Polyester Polyamide Silk

Twisted:

Cotton
Linen

Salient features

Catgut:

From mucosa of jejunum of sheep
Yellowish white in colour
Absorbed by inflammatory reaction and phagocytosis
Absorption time: 7 days

Chromic catgut:

Catgut coated with chromic salt
Brown in colour
Absorption time: 21 days

Vicryl:

Synthetic, multifilamented, braided, violet in colour
Absorption time: 90 days
Absorbed by hydrolysis

Silk:

Natural, multifilamented, braided, black
From cocoon of silkworm larva
Coated to reduce capillary action

Polypropylene:

Synthetic, monofilament, blue colour
High memory

Dent-Ed