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In the name of Ulla the most

compassionate the most


merciful

Suture materials
Definition
• A natural (catgut, silk, or linen) or
synthetic, or other (thin metal
wire) monofilament or
multifilament material used
surgically to close a surgical or
accidental wound and to secure
apposition of the edges and join
tissues.
• Three properties of a suture
material affect its handling:
memory, elasticity, and knot
strength.
• Tensile strength, tissue reaction,
and capability to be absorbed are
other important characteristics of
the suture material.
Background
• The wounds were closed in 3000
BC by the Egyptians using thorns
and needles.
• By 1000 BC Indian surgeon were
using horsehair, cotton and
leather sutures.
• In Roman times, linen, silk and
metal clips called fibulae were
commonly used to close
gladiatorial wounds.
• By the end of the nineteenth
century both silk and cut gut
became popular as suture
materials.
• All the natural sutures silk, cotton,
linen and cut gut are being
replaced by polymeric synthetic
materials now.
• They can be manufactured as
monofilaments or braids, and can
be coated with wax, silicone or
polybutyrate (to allow them to run
smoothly through tissues and to
knot securely).
Feature of ideal suture
material
• Adequate tensile strength.
• Good knot holding property.
• Should be least reactive.
• Easy handling property.
• Should have less memory.
• Should be easily available and
cost effective.
CLASSIFICATIN I

ABSORBABLE SUTURE
MATERIALS
1- Plain catgut is derived from sub
mucosa of jejunum of sheep.
- It is yellowish white in color.
- It is absorbed by inflammatory
reaction and phagocytosis.
- It is used for subcutaneous tissue,
muscle, circumcision in children.
2- Chromic catgut is catgut with
chromic acid salt.
- It is brown in color.
- It is used for suturing muscles,
fascia, external oblique
aponeurosis, ligating pedicles.
3- Vicryl (Polyglactic acid).

- It is synthetic absorbable suture


material.
- Absorption is by hydrolysis.
- It is violet in color (braided).
- It is multifilament and braided.
- It is very good suture material for
bowel anastomosis, suturing
muscles, closure of peritoniem.
4- Dexon ( Polyglycolic acid)
- is synthetic absorbable suture
material like vicryl.
- It is creamy yellow in color
(braided).
5- Maxon (Polyglyconate)
monofilament.
6- PDS (Poly Dioxanone Suture
material) is absorbable suture
material.
- It is creamy in color with
properties like vicryl (better suture
material than vicryl).
7- Monocryl( Polyglecaprone).
8-Biosyn (Glycomer) monofilament.
Non absorbable suture materials

1-Silk is natural multifilament and


braided derived from cocoon of
silkworm larva.
It is black in color and coated to
reduce capillary action.

2- Polypropylene (prolene) is
synthetic monofilament suture
material. Blue in color
- It has got high memory( memory of
suture materials is recoiling
tendency after removal from the
packet. Ideally suture material
should have low memory). (prolen
mesh used for hernioplasty is in
white color).
3- Polyethylene (ethylene) is
synthetic monofilament black in
color.
4- Cotton is twisted multifilament
natural non absorbable and white
in color.
5- Linen is derived from bark of
cotton tree.
6- Steel, polyester, poly amide,
nylon are other non absorbable
suture materials.
CLASSIFICATION II
Natural Synthetic
1- Catgut. 1- Vicryl
2- polyester 2- Dexon
3- Silk. 3- PDS
4- polyamide 4- Maxon
5- Cotton 5- polypropylene
6- Linen 6- polyethylene
CLASSIFICATION III
Braided Twisted
1- Polyester 1- Cotton
2- Polyamide 2- linen
3- Vicryl
4- Dexon
5- silk
CLASSIFICATION IV

Monofilament Multifilament
1- Polypropylenes
1- polyester
2- polyethylene2- polyamide
3- PDS 3- vicryl
4- Catgut 4- dexon
5- Steel 5- silk
6- cotton
CLASSIFICATION V
1- Coated 2- Un coated
Choice of suture materials

• The choice of suture material is


important. Foreign material in the
tissue predisposes to infection.

• The finest sutures that will hold


the wound edges together should
be used.

• Wound are often subjected to


stress post operatively and
whereas 5/0 or 6/0 suture are
appropriate for the face.
• Stronger ones 3/0 or 4/0 are
needed for incisions near joints
and still stronger ones for the
abdominal wall.

• The suture should be strong


enough to support the wound
until tensile strength has
recovered sufficiently to prevent
breakdown.

• Absorbable materials are used


for buried layers.

• But is used in some situation (in


apponeurosis layer of an
abdominal wound).
Uses of absorbable suture
materials:
• In bowel anastomosis like
gastrojejunostomy, resection and
anastomosis (usually vicryl).
• In cholecystojejunostomy (CCJ),
choledochojejunostomy (CDJ),
pancreaticojejunostomy (usualy
vicryl).
• In suturing muscle, fascia,
peritoneum, subcutaneous tissue,
mucosa.
• in ligating pedicles. Usually 1-0
chromic catgut or vicryl are used

(ligation of pedicles during
hysterectomy).
• In circumcision, usually 3-0 plain
or chromic catgut are used.
Never use absorbable suture
material for suturing of
tendon, nerve and vessels.
Uses of non absorbable
suture materials

1- In herniorrhaphy for repair.


2- For closure of abdomen after
laparotomy.
3- For vascular anastomosis (6-0)
nerve suturing and tendon
suturing.
4- For tension suturing in the
abdomen.
5- For suturing the skin.

Silk and linen should not use for


vascular prosthesis
Tissue reaction

• Catgut (plain) is high and Catgut


(chromic) moderate.
• For other absorbable suture
materials is mild to minimal.
• Silk is high and linen is moderate.
• For other non absorbable are
minimal to low.
Absorption rate

• Catgut plain 7-10 days.


Catgut chromic 21 days.
Vicryl 90 days.
Dexon
60-90 days.
PDS (monofilament) 180 days
• Polyglycaprone (monofilament) 90-120
days.

• Silk 1-2 years


• Linen remain encapsulated
• Nylon 15-20% per year
• Surgical steel remain encapsulated

• Prolene remain encapsulated


Numbering of suture material

2
1 For pedicle ligation
0
1-0
2-0
3-0 For bowel suturing
4-0
5-0
6-0
7-0 For vascular anastomos
8-0
0-9 For ophthalmic surgery
requiring operating microscop
Metal sutures, clips and staples

There are three basic types of


gastrointestinal stapling device:
• Linear stapler. A linear everting
staple line is fashioned used for
closure of a visvus (duodenum,
stump closure after Polya
gastrectomy).

• End to end stapler,


circular inverting anastomosis
used for end to end
gastrointestinal anastomosis
(closure of colostomy).
• Side to side stapler with or
without a knife blade for
transection of a viscus between
staple rows.

Metal clips for skin allow quick


accurate closure. Skin clips are
easy to remove with_
an appropriate supplied device and
gives acceptable scars with a low
infection rate.
● Stainless steel wire suture have
their place for the closure of the
sternum after cardiac operation
and in orthopaedic surgery.
Tissue glues
• The cyanoacrylates are have been
used for skin closure but require
near perfect haemostasis. the use of
tissue glues is not widespread
despite much published work.
Fibrin tissue glues
• Work on the conversion of
fibrinogen by thrombin to fibrin with
cross linking by factor XIII.
• the addition of aprotinin retards
break up of the fibrin network by
plasmin.
• The fibrinous network produced has
good adhesive properties and has
been used for haemostasis in the
liver and the spleen.
● It has also been used in
neurosurgery for dural tears, ear,
nose, and ophtalmic surgery.
Needles
• The choice of surgical needle is
as important as the choice of
suture.
• The needle holder chosen also
need to be appropriate, a large
one a small needle and a large
needle is unmanageable in a
small needle holder.
• The appropriate size and shape of
cutting of round-bodied a
traumatic needle needs to be
chosen for the least traumatic
passage of tiss
● Shaped needles allow easier
access for suturing.
• The J-shaped needle useful in low
approach femoral hernia repair.
• The compound curve needle use
in ophtalmic surgery.
• Hand needles should be avoided
because of the risk of needle stick
injury.
• Proposed by. Specialist
(Professor) Saborzai trainer
and chief of general surgery.

• Directed by Specialist
M.Khakid trainer of general
surgery.

• Prepared by Dr. A.H.Ferotan


2nd PGY of Jamhuriat training
Hospital

• Date: 25-02-88