VARIOUS SUTURE MATERIALS AND NEEDLES USED FOR SURGERY.

1. SUTURE MATERIALS
Presented By Dr Sachin B R
Guided by Dr Bhaskar M

2. • Suture means to ‘sew’ or ‘seam’. In surgery suture is the act of sewing or bringing
tissue together and holding them in apposition until healing has taken place.
• A suture material is a strand of material used to ligate blood vessels or to
approximate tissues together.

3. History
The first sutures were fashioned from hair, cotton, tendon, or silk.They were used
on needles made of bone, stone, or wood.
Horse hair, Leather, linen sutures have been used historically
Romans used linens, silk and metal clips
African tribes used Acacia thorns with strips of vegetable matter
South American tribes used black ants
Catgut and silk became popular in the 19th century

4. Wound healing
Phases of wound healing
• Coagulation begins immediately following injury
• Epithelialization of the surgical repair should occur within 48 hours of suturing
• New blood vessel growth peaks at 4 days
• Collagen reformation starts at 48 hours, peaks at 1 week and continues for 12 months
• Wound contraction starts 3-4 days and can last up to 2 years after the injury / repair

5. Surgical needle

6. Components of a surgical needle
• The eye
• Body
• Point
• Needle with eye are more traumatic than the swaged

8. The most common shapes are:
1) Quarter circle:
It has a little curvature, use on convex surface and
delicate surgery, typically use on ophthalmic procedures,
facial aesthetic, eyelids, fascia, and microsurgery.
2) One-half circle:
It has a large arc to use in confined sites, the application
area is skin, muscle, peritoneum, eye, abdominal
surgery and gastrointestinal tract.
3) Three- eighths circle:
The most common needles use in large and superficial
wound and it’s impossible to use in deep cavities. This
needle applied in skin, hand surgery, fascia, muscle,
subcuticular.

9. 4) Five-eighths circle:
These needles perfect with deep and confined cavities
due to the needle design make a maneuvering in small
location easier. Application area Intraoral, urogenital,
and anorectal procedures.
5) One-half curved (ski needle):
The curved portion for this needle passes through
tissue easily, used in laparoscopic technique and skin
closure.
6) j shape needle:
Used on deep incision so it used in laparoscopic
surgery without any injury to visceral and applied in
vagina and rectum.
7) Compound curved needles:
Used on oral, eye and anterior segment ophthalmic
surgery.
8) Straight needle:
Can be used without needle holder as is the case of
curvature needle and there is a high risk of accidently
sticking yourself. It uses in easily accessible tissue,
typically in abdominal surgery, rhinoplasty.

10. Correct use of needle includes:
1.Appropriate balance between needle size and needle holder size whereas
biggest size of needle requires heavy needle holder and for smaller needle
delicate needle holder are recommended.
2.Needle holder should grasp needle away of swage or eye needle area to avoid
crimping damage and needle should be grasped approximation ¼ to ½ the length
from needle point side.
3.Don’t close the needle holder too tightly during needle grasp to avoid break the
needle.

13. • Commonly, surgical needles are made from stainless steel. They are
composed of:
• The swaged end connects the needle to the suture
• The needle body or shaft is the region grasped by the needle holder. Needle
bodies can be round, cutting, or reverse cutting:
• Round bodied needles are used in friable tissue such as liver and
kidney
• Cutting needles are triangular in shape, and have 3 cutting edges to
penetrate tough tissue such as the skin and sternum, and have a
cutting surface on the concave edge
• Reverse cutting needles have a cutting surface on the convex edge,
and are ideal for tough tissue such as tendon or subcuticular sutures,
and have reduced risk of cutting through tissue
• Taper cut
• Blunt

15. • Round bodied needle

16. Conventional cutting needle

17. Reverse cutting needle

18. • The needle shape vary in their
curvature and are described as
the proportion of a circle
completed – the ¼, ⅜, ½, and ⅝
are the most common curvatures
used. Different curvatures are
required depending on the
access to the area to suture.

19. • Broadly, sutures can be classified into absorbable or non-
absorbable materials. They can be further sub-classified
into synthetic or natural sutures,
and monofilament or multifilament sutures.
Suture Material

20. Absorbable Sutures
• Absorbable sutures are broken down by the body via enzymatic reactions or
hydrolysis. The time in which this absorption takes place varies between
material, location of suture, and patient factors.
• Absorbable sutures are commonly used for deep tissues and tissues that heal
rapidly; as a result, they may be used in small bowel anastomosis, suturing in the
urinary or biliary tracts, or tying off small vessels near the skin.
• For the more commonly used absorbable sutures, complete absorption
times will vary:
• Vicryl rapide = 42 days
• Vicryl = 60 days
• Monocryl = ~100 days
• PDS = ~200 days

21. Absorbable
• Plain surgical gut (catgut)
• Chromic catgut
• Collagen
• Polyglycolic acid (Dexon)
• Polyglactin 910 (Vicryl)

22. Non-absorbable sutures
• Non-absorbable sutures are used to provide long-term tissue support,
remaining walled-off by the body’s inflammatory processes (until removed
manually if required).
• Uses include for tissues that heal slowly, such as fascia or tendons, closure of
abdominal wall, or vascular anastomoses
• Silk
• Cotton
• Nylon
• Dacron (Mersilene)
• Polypropylene (Prolene)
• Stainless steel
• Titanium

23. Synthetic vs Natural
• Suture materials can be further categorised by their raw origin:
• Natural – made of natural fibres (e.g. silk or catgut). They are less frequently
used, as they tend to provoke a greater tissue reaction. However, suturing silk is
still utilised regularly in the securing of surgical drains.
• Synthetic – comprised of man-made materials (e.g. PDS or nylon). They tend
to be more predictable than the natural sutures, particularly in their loss of
tensile strength and absorption.

24. Monofilament vs Multifilament
• Suture materials can also be sub-classified by their structure:
• Monofilament suture – a single stranded filament suture (e.g nylon, PDS*, or
prolene). They have a lower infection risk
• but poor knot security and ease of handling.
• Fracture during handling is common
• Multifilament suture – made of several filaments that are twisted together (e.g
braided silk or vicryl).
• They handle easier and hold their shape for good knot security, yet can harbour
infections due to the capillary action and more tissue trauma due to sawing action.

25. Suture material: desired characteristics
(The ideal suture is yet to be produced)
1) Easy to handle
2) Predictable behavior in tissues
3) Predictable tensile strength
4) Sterile
5) Glides through tissues easily
6) Secure knotting ability
7) Inexpensive
8) Minimal tissue reaction
9) Non-capillary
10) Non-allergenic
11) Non-carcinogenic
12) Non-electrolytic
13) Non-shrinkage

26. Five characteristics of any suture material
that need to be considered:
1. Physical structure: Monofilament vs multi filament

29. 2. Strength:
what’s it made of
thickness
how it is handled by the tissues
Absorbable show a decay in the tensile strength with the passage of time
Five characteristics of any suture material
that need to be considered:

32. 3.Tensile Behavior
Elasticity: Material returns to its original length once any tension is
released
Plasticity : Material stretches and retains its length after stretching
does not hinder circulation on the tissues by elongating
without stressing or cutting the tissues.
Memory: Ability to retain the shape they adopted within the
packaging- decreases the knot security.
NOTE: Sutures lose 50% of their strength at the knot
Five characteristics of any suture material
that need to be considered:

33. 4. Absorbability: Suture materials for use in biliary and urinary tract needs to be
absorbable to minimize the risk of stone formation.
Vascular anastomosis requires non absorbable material and it is wise to avoid
braided material.
Non absorbable materials tend to be preffered where persistent strength is required
as artificial graft or prosthesis fully heals or integrates into host artery-
polypropylene are almost universally used,
Five characteristics of any suture material
that need to be considered:

34. • 5) Biological Behaviour:
• Catgut: Proteolyzed – not entirely predictable
• Synthetic polymers- Hydrolyzed and their disappearances are more
predictable
• In infected tissues or in a patient who is febrile or protein
deficient, suture breakdown may be accelerated
Five characteristics of any suture material
that need to be considered:

35. Biological response of body to suture
materials
• Natural Absorbable – Proteolytic degradation. Intense tissue response
• Synthetic Absorbable – Hydrolysis. Less Intense
• Non Absorbable – Encapsulation. Acellular Response

36. The selection of suture material is based
on:
• ❑The condition of the wound,
• ❑The tissues to be repaired,
• ❑The tensile strength of the suture material
• ❑Knot-holding characteristics of the suture material and
• ❑The reaction of surrounding tissues to the suture materials

42. SutureType Absorbable Non Absorbable Monofilament Multifilament
Vicryl √ √
PDS √ √
Monocryl √ √
Nylon √ √
Prolene √ √
Silk √ √

44. Absorbable suture materials
• Catgut
• Collagen derived from healthy sheep or cattle intestinal submucosa
• Tensile strength lost in 7-10 days, Absorption in 40-60 days
• Cleared by enzymatic degradation and phagocytosis
• High tissue reaction
• Not used for tissues that heal slowly and require prolonged support
• Packaged in isopropyl alcohol as a preservative (since highly susceptible to enzymatic degradation)
• Frequently used to ligate superficial vessels, oral mucosa, stomas, in circumcision and other tissues
that heal rapidly
• Can be tanned with chromium salts that slowdown phagocytosis and helps retain tensile strength for
21-28days, absorption in 90 days.

46. Polyglactin
• Copolymer of lactide and glycolide in 90:10 ratio, coated with polyglactin and
calcium stearate
• Braided multifilament
• Retains around 60% tensile strength in two weeks and 30% at 3 weeks
• Mild tissue reaction and hydrolyses in the body, complete absorption in 60-90days
• WORKHORSE suture for many application in most general surgery practices
• VICRYL

48. Polydiaxone(PDSII)
• Polyester polymer
• Monofilament
• Dyed or undyed
• 70% tensile strength remains in two weeks
• Complete absorption in 180 days
• Significant memory affects knot security
• Used as absorbable sutures where slightly longer wound support is needed
compared to vicryl.
• Minimal tissue reaction

49. Polyglycaprone
• Copolymer of glycolite and caprolactone
• Monofilament
• Tensile strength retained for 21 days
• Complete absorbtion in 90-120 days
• Mild tissue reaction
• Used in subcuticular in skin and ligation, gi and muscle surgery

50. Polyglycolic acid
•Polyglycolic acid and trimethylene carbonate
•Mono filament
•Tensile strength retained 14-21 days
•Absorbed in 180 days
•Degradation products shown to have antibacterial
properties.

52. Non absorbable suture materials
• SILK:
• Natural protein – from silkworm cocoon
• Braided, twisted multifilament
• Dyed or undyed
• Coated or uncoated
• Loses 20% when wet; 80–100% lost by 6 months.
• Because of tissue reactions and unpredictability, silk is
increasingly not recommended

53. • Studies show that most ofTS is lost in 1yr and material not
found in tissues in 2 years.
Frequently used for ligation and suturing of vessels
• Drain fixing
• Available from 10/0-2 to 4/0

55. Nylon
• Synthetic – Polyamide polymer
• Monofilament or multifilament
• Loses 15-20% tensile strength per year
• Low tissue reaction
• Skin, abdominal wall mass closure, hernia repair, neurosurgery, plastic surgery
• Available from 11/0-2

57. Polyster
• Polyethylene terephthalate
• Monofilament or braided multifilament
• Dyed or undyed
• Coated or uncoated
• Tensile strength remains for infinite time(more than 1 year)
• Used in cardiovascular, ophthalmic, plastic and general surgery
• Available from 11/-1

58. Polybutester
• Polybutylene terephthalate and polytetramethylene ether glycol
• Monofilament
• Dyed or undyed
• Tensile strength is infinite(more than 1 year)
• Low tissue reaction
• Exhibits elasticity, particularly used in plastic surgery, stretches with wound
edema and still retainsTS once edema subsides,
• Available from 7/0-1

59. Polypropylene
• Polymer of propylene
• Monofilament
• Dyed or undyed
• Infinite tensile strength
• Low tissue reaction
• Used in general surgery, cardiovascular, ophthalmic , subcuticular skin closure
• Available from 10/0-1

61. Surgical steel
• An alloy of iron, nickel and chromium
• Monofilament or multifilament
• Tensile strength is infinite
• Minimal tissue reaction
• Used in sternotomy wounds closure, spine fixation etc

64. Plus sutures
• Sutures coated with drug
• Intented to reduce bacterial adherence and reduce infection