Suture Materials

HISTORY OF SUTURES

Earliest Reference
EDWIN SMITH PAPYRUS 1600 BC
GALEN AD 150 ON CATGUT
LISTER CARBOLISED CATGUT
SUTURE IS A STRAND OF ANY MATERIAL
USED FOR

• Ligating Blood vessels

• Transfixing
• Approximating tissues
THE IDEAL SUTURE
Moynihan 1912
• Monofilament
• Absorbable
• Predictable absorption
• Use for any Procedure
• Easy to handle
• Minimal Tissue Reaction
• High Breaking Strength
• Holds Knots Securely
• Sterile
Choice of suture

• Familiarity
• Ease of handling
• Tissue characteristics
• Knowledge of physical and biological
characteristics of the suture
• Patient factors-
infection,debility,obesity
CLASSIFICATION OF SUTURES

ABSORBABLE NONABSORBABLE

MONOFILAMENT BRAIDED

SYNTHETIC NATURAL
 CLASSIFICATION OF SUTURES

Plain/F.A. Gut
Silk
Natural
Natural Chromic Gut

VICRYL* Rapide
ETHIBOND*
VICRYL*
Synthetic Synthetic
ETHILON*
MONOCRYL*
PROLENE*
PDS II*
Stainless Steel

ABSORBABLE SUTURES NON - ABSORBABLE

SUTURES
ABSORBABLE

ADVANTAGE
– Broken down by body
– No Foreign body left

DISADVANTAGE
– Time of Wound Support
NONABSORBABALE

ADVANTAGE
– Permanent Wound Support

DISADVANTAGE
– Foreign body left
– Suture Sinus
– Suture Extrusion
MONOFILAMENT
ADVANTAGE
– Smooth Surface
– Low Friction
– Less Drag
– Less Tissue Trauma
– Less Tissue Infection
– No Capillarity
MONOFILAMENT

DISADVANTAGE

– Handling and Knotting

– Stretch ability and bending-
PLIABILTY
BRAIDED

ADVANTAGE
– Strength
– Soft and Pliable
– Good Handling
BRAIDED

DISADVANTAGE

-Capillary Action
-Tissue Trauma
-Tissue Drag
-Tissue Cutting
-Harbors bacteria
In vivo performance of
absorbable sutures

• tensile strength retention

• Absorption rate
CATGUT
• 99% PURIFIED COLLAGEN FROM
SUBMUCOSA OF SHEEP INTESTINE
• ESSENTIALLY MONOFILAMENT
• PROCESSED BY TRU GAUGING
WHICH ENSURES UNIFORM
DIAMETER AND TRU CHROMICISING
WHICH ADDS STRENGTH
• AVAILABLE AS PLAIN AND CHROMIC
CATGUT
PLAIN CATGUT

• TENSILE STRENGTH 7-10 DAYS

• ABSORPTION -70 DAYS
• CAUSES MORE TISSUE REACTION
• USES- TO LIGATE SUPERFICIAL
BLOOD VESSELS,SUBCUTANEOUS
TISSUE,LIP AND ORAL MUCOSA
CHROMIC CATGUT
• CHROMICISING ALTERS THE SHADE TO
BROWN
• RESISTS DIGESTIVE ENZYMES AND
PROLONGS ABSORPTION
• LESS TISSUE REACTION
• TENSILE STRENGTH LASTS 10-14 DAYS
• ABSORPTION IN 90-110 DAYS
• USED IN ALL GYNECOLOGICAL
PROCEDURES,SUTURING
PERITONEUM,MUSCLES AND FASCIA
• STORED IN A FLUID THAT KEEPS IT
SUPPLE AND HYDRATED
• STERILISED BY GAMMA IRRADIATION
WITH 2.5 MEGA RADS
• REACTION TO IMPURITIES OR
MUCOPOLYSACCHARIDES RARE
CATGUT ABSORPTION
PLAIN CHROMIC

WOUND SUPPORT
7 – 10 days 10-14 days

MASS ABSORPTION
60 – 90 days 90 – 110 days
 SYNTHETIC
ABSORBABLE
SYNTHETIC ABSORBABLE
• POLYGLACTIN 910(VICRYL)
• COATED POLYGLACTIN370
• GAMMA IRRADIATED COATED
POLYGLACTIN (VICRYL RAPIDE)
• POLYGLICAPRONE
25(MONOCRYL)
• CAPROFYL
• PDS AND PDS II
SYNTHETIC ABSORBABLES
• PREPARED FROM CARBOHYDRATES
• TWICE AS STRONG AS NATURAL
ABSORBABLES
• AVAILABLE AS MONOFILAMENT AND
BRAIDED
• DEPENDABLE ABSORPTION RATE
• FULLY ABSORPED AND LEAVE BEHIND NO
FOREIGN BODY
• ABSORPTION BY HYDROLYSIS
• EXCELLENT HANDLING
• STERILISED BY ETHYLENE OXIDE AND
SHELF LIFE OF 5 YARS
VICRYL

• POLYGLACTIN AND LACTIDE IN 9:1

POLYMER SEQUENCE
• MAINTAINS 60% STRENGTH AT 2
WEEKS,30% AT 3 WEEKS
• ABSORPTION COMPLETE AT60-90
DAYS
COATED VICRYL
• HAS POLYGLACTIN 370 COATING ON
POLYGLACTIN 910
• POLYGLACTIN 370 HAS 50%
POLYGLACTIN (65% GLYCOLIDE AND
35% LACTIDE)AND 50%CALCIUM
STEARATE
• COATING REDUCES SURFACE
TENSION AND BEHAVES AS A
MONOFILAMENT
Coated VICRYL

• STRENGTH RETENTION

• At 14 days – 75 % Tensile Strength

remains

• At 21 days - 50 % Tensile Strength

remains
Coated VICRYL

• WOUND SUPPORT : 28 – 35 DAYS

• MASS ABSORPTION : 56 – 70 DAYS

VICRYL RAPIDE
• COATED POLYGLACTIN 910 EXPOSED TO
GAMMA IRRADIATION WHICH MAKES IT
LOW MOLECULAR WEIGHT WITH A TENSILE
STRENGTH 30% LESS
• LOSS OF TENSILE STRENGTH BETWEEN 10-
12 DAYS
• ABSORPTION COMPLETE in 42 DAYS
• USED FOR SKIN/MUCOSA,ORAL/VAGINAL
• SKIN GRAFTS,CIRCUMCISION
MONOCRYL
• 75% GLYCOLIDE AND 25%
CAPROLACTONE
• DYED VIOLET OR UNDYED
• HIGHEST STRENGTH AMONG
ABSORBABLES
• MOST PLIABLE WITH EXCELLENT
HANDLING PROPERTIES
• LOWEST STIFFNESS INDEX
• TENSILE STRENGTH IS 60% AT 1 WEEK
AND 0% AT 21 DAYS
• ABSORPTION COMPLETE 90-120 DAYS
USES

• SUBCUTANEOUS CLOSURE
• SUBCUTICULAR SKIN CLOSURE
• UROLOGICAL PROCEDURES
• BOWEL ANASTOMOSIS
• PERITONEAL CLOSURE
PDS AND PDS II
• POLYDIOXANONE SUTURES FORMED
BY POYMERISING MONOMER-PARA
DIOXANONE IN PRESENCE OF A
CATALYST
• UNIQUE FEATURE OF FLEXIBILITY
• TENSILE STRENGTH 70% AT 2 WEEKS
AND 25% AT 6 WEEKS
• ABSORPTION 180-210 DAYS
USES

• WOUND CLOSURE
• CAESEREAN AND MYOMECTOMY
• ORTHOPEDIC SURGERY
• G.I SURGERY
• CARDIOVASCULAR SURGERY
contraindication

• Conjunctival suturing
• Cuticular sutures
• Vaginal epithelial sutures
NON ABSORBABLE

• BLACK SILK(MERSILK)
• NYLON(ETHILON)
• POLYPROPYLENE(PROLENE)
• PRONOVA
• ETHIBOND EXCEL
• MERSILENE
• STAINLESS STEEL(ETHISTEEL)
MERSILK

• Natural Nonabsorbable – Braided

• Made from Silkworm Cocoons

• Twisted Virgin Silk

• Braided Wax Coated Silk

Black Braided Silk

In-Vivo Profile

• Tissue Reaction - Moderate

• BSR - Looses T.S - 3 Months

• Absorption - Fragments & absorbs 6-8 months

MERSILK

• Very Good Handling

• Very Good Knotting

• Standard for many years

ETHILON

• First Synthetic Monofilament

Nonabsorbable

• Replaced Monofilament Silk

• Used mainly in Skin and Abdominal Closure

ETHILON
Drawbacks:

• Nylon Absorbs Water

• Loses Strength at a rate of 15 % per

annum

• Suture Sinus and Extrusion in some

cases
NYLON
(ETHILON)
• Smooth, Easy passage through tissue
• No Bacterial harbours or Capillarity
• Strong, Controlled Elasticity allows Ultra
Fine Gauges

• Provided Long term Wound Support

• Can be used in many applications including
Opthalmics and Microsurgery
PROLENE

• Synthetic

• Nonabsorbable

• Monofilament
PROLENE

• Monofilament to replace Nylon

• Better Control of Stretching
Properties

• More Pliable for handling and

knotting

• Smoothest Suture Surface ever

PROLENE

• Extends upto 30% before Breaking

• Indefinite Tensile Strength
• Excellent Handling
• Secured Knotting
• Sterilised by EO
• Inert and Non-Biodegradable
• Less Thrombogenic
MONOFILAMENT KNOTTING
Suture preference
• Skin- braided silk, monocryl,nylon,vicryl
rapide
• Subcutaneous tissue- chromic/plain
catgut,vicryl
• Fascia,muscle- chromic catgut,vicryl
• Peritoneum- monocryl,vicryl, prolene
• Rectus sheath- prolene
• Vaginal mucosa- vicryl rapide, catgut
• Episotomy suture- vicryl rapide
THANK
YOU
 mbbsBasic
www.mbbsbasic.com