- Sutures play an important role in wound healing after surgery. The ideal suture material is sterile, causes minimal tissue injury, is easy to handle, has high tensile strength, and resists infection. - Suture materials can be absorbable, non-absorbable, natural or synthetic. Common natural sutures include catgut and silk, while synthetic options include Vicryl, PDS, Monocryl, Prolene, and nylon. - Absorbable sutures provide temporary wound support until healing, while non-absorbable sutures offer longer-term support. Selection depends on factors like tissue type and tension. Proper suture and

1. Suture materials
Dr.prakash Patel
Dept. of Surgery
GMC, Surat

2. • Wound healing includes series of phases
• Sutures play an important role in wound
healing after surgical interventions
• So selection of suture material is more
important.

3. IDEAL SUTURE MATERIAL
• Sterile
• Can be used in any tissue
• Causes minimal tissue injury or tissue reaction (non
capillary , non allergic, non carcinogenic)
• Easy to handle
• Uniform diameter
• Holds securely when knotted ( no fraying /cutting )
• High tensile strength
• Favourable absorption profile
• Resistant to infection

4. Tensile strength
• It is amount of force required to break suture
material.
• It is maintained for longer duration in non
absorbable sutures as compared to
absorbable sutures

5. • Suture material is classified according to
structure of material
– Monofilament
– Polyfilament ( Brided / twisted )

6. • Classified according to nature of absorption
– Absorbable / Delayed absorbable
– Non Absorbable

7. • Classification according to Type of material
– Natural
– Synthetic

8. Natural V/s Synthetic
– Natural sutures may cause tissue reaction and
suture antigenicity leads to inflammatory
reactions
– Synthetic materials
– Less reaction
– Less inflammatory reaction

9. • Absorption occurs by enzymatic degradation
in NATURAL materials
• By Hydrolysis in SYNTHETIC materials
• Hydrolysis causes less tissue reaction than
enzymatic degradation.

10. Absorbable V/s Non Absorbable
• Nonabsorbabale sutures offer longer
mechanical support
• Absorbable sutures provide temporary wound
support untill the wound heals well enough
to withstand normal stress.

11. Monofilament V/s Multifilament
• Monofilament sutures is made of a single strand
 infection is avoided.
• Resistant to harboring micro organisms.
• Monofilament sutures exhibit less resistance to
passage through tissue  less tissue trauma.
• Multifilament suture is composed of multiple
fibres
• It can be arranged in twisted or braided manner

12. • Multifilament suture has greater tensile
strength, better flexibility
• Multifilament suture hold knots very well as
compared to monofilament suture
• Because of multiple filaments it increased
absorption of fluid and may act as tract for
infection.

13. • Disadvantages of Monofilament suture
– More stiff
– Memory is more so difficult to handle
– Knot holding is difficult

19. Catgut
• Plain catgut
• Chromic Catgut

20. • Derived from submucosa
of sheap intestine or
serosa of beef intestine
• Submucosa of sheap
intestine has rich elastic
tissue which account for
high tensile strength
• It is monofilament
• It is available as plain as
well as chromic catgut

21. • Chromic catgut is plain
catgut suture tanned
with chromic acid.
• Tanning process
minimise tissue reaction
delays digestion by
white blood cell
lysozymes.
• More tensile strength.
• Better knot security.

22. • Catgut should not be boiled or autoclaved as
heat destroys its tensile strength.
• Catgut is sterilized during preparation and
kept in a preservative solution (Isoporpyl
alcohol) inside foils.
• Catgut is hygroscopic so it will swell due to
water absorption and its tensile strength will
be reduced.

23. • It is available pre sterilized in aluminium
coated sterile foil over wrap pack with ethicon
fluid as a preservative.
• COLOUR – plain Catgut – yellow
• Chromic catgut – Tanned ( dark yellow)
• USES- Oral surgery , Subcutaneous tissue
suturing , lap.appendisectomy .

24. VICRYL ( Polyglactin )
• Absorbable synthetic suture
• Copolymer of lactide and glycolide.
• Minimal tissue reaction.

25. • Available in purple and undyed .
• Coated with polyglactin 370 and calcium
stearate which makes suture smooth easy
passage and easier knot placement.

26. PDS
• Polydioxanone (PDS) is synthetic,monofilament
,absorbable suture.
• Passes through tissue easily
• Memory is more than multifilament
• Absroption done by hydrolysis in months
• Tensile strength 14-42 days
• Minimal tissue reaction
• Uses – for wound under tension or contaminated
wound.

27. • Blue in colour

28. MONOCRYL
• Monocryl ( poliglecaprone 25) is Synthetic
monofilament absorbable suture
• Tensile strength remains for 2-3 weeks
• Less tissue reaction
• Uses- for mucosa and skin suturing.

29. • Other absorbable sutures commonly used are
• Vicryl Rapid – white colour
• Vicryl Plus – Having atibactarial property
which make antibacterial cover surrounding
suture
• Dexon – made up of homopolymer of glycolic
acid . , monofilament, absorbable , tensile
strength 3-4weeks .

30. Non absorbable sutures
• Natural – silk , cotton
• Synthetic – polyester , polyamide,
polypropylene, polyethelene,nylon
• Metalic – stainless steel , platinum , silver ,
gold

31. Surgical Silk
• Multifilament – Braided or twisted.
• Made from silkworm larva.
• Filaments from silkworm larva is processed to
remove natural waxes , after braiding strands
are dyed , stretched and impregnated with
mixture of waxes and silicone .

32. • Black in colour
• Easy handling
• Good knot security

33. • It is degraded by proteolysis
• Uses- used in ligating blood vessels, intestinal
anastomosis , feeding jejunostomy, mesentric
suturing.

34. Surgical cotton sutures
• Natural , multifilament , non absorbable
• Made up from cotton fibres
• God knot security
• Not good in presence of infection
• Rarely used nowadays
• Uses- tissue ligating and suturing.

35. Polypropylene( PROLENE)
• Polymer of propylene.
• Inert and tensile strength remains for 2 years
• Monofilament
• Less tissue reactions so can be used in
infected or contaminated wound.
• Uses – sheath closure , tendon repair, hernia
repair , mesh fixation , vessels repair
,pancreatic anastomosis .

36. • Blue colour

37. Nylon ( Ethilon)
• Monofilament , nonaborbable
• High tensile strength
• Low tissue reaction
• Memory is retained , so difficult to handle
• More knots are required to securing knots.
• Uses – for skin closure ,plastic and ophthalmic
surgery .

38. • Black colour

39. Surgical metalic wires
• surgical steel – very high tensile strength
• Difficult to handle
• Tendancy to cut through tissue
• Difficult in knot tie, knot ends require special handling
• Uses- sternotomy closure .
• Disadvantages – it can be seen in Ctscan images as
arteffects
• During MRI possiblity of suture movement is there.

40. Suture size
• Largest size 1 to extremely fine 11-0.
• Increasing number of zero correlates with
decreasing diameter and strength.
• Thicker sutures are used for approximations of
deeper layers , wounds in tension prone areas,
and ligation of major blood vessels
• Thin sutures are used for closing delicate tissues
like conjunctiva , facial skin.
• Size is chosen to correlate with tensile strength of
tissue being sutured .

44. SUTURE NEEDLE
• Surgical needles are designed to lead suture
material through tissue with minimal injury.
• Needles can be – straight or curved
– Swaged (eyeless)or eyed
• Made up of stainless steel or carbon steel
• Needle is selected according to :
– Type of tissue to be sutured
– Tissue accessibility
– Diameter of suture material

45. Classifications of surgical needles
• According to Eye –
– Eyeless
– With eye.
• According to shape
– Straight needles
– Curved needles
• According to cutting edge
– Round body
– Cutting –
• conventional
• Reverse cutting
• According to tip
– Triangular tip
– Round tip
– Blunt tip

53. TYPES OF SUTURING