1) Sutures are used to bring tissue together and can be made of absorbable or non-absorbable materials. 2) Key properties of sutures include tensile strength, absorbability, knot strength, configuration, elasticity, and tissue reactivity. 3) Common suture materials include natural sutures like gut and collagen as well as synthetic absorbable sutures like polyglactin and polyglycolic acid or non-absorbable sutures like silk, nylon, and polyester.

1. BY:--- DR. PRIYANKA GUSAIN
(JUNIOR RESIDENT)
(GMC, AMRITSAR)

2.  Suture: as a verb is the act of sewing by
bringing tissue together.
 Suture as a noun is a material used to bring
tissue together.

3. 1)TENSILE STRENGTH- It is duration of suture
holding in the tissue.It can be tested by
special device called tensiometer.
2)ABSORBABILITY-It is duration of suture degra
-dation in the tissue. Two types :
1) enzymatic degradation
2) hydrolytic degradation
3)KNOT STRENGTH- It is the force required for
the knot to slip.

4. 4) CONFIGURATION
a) Monofilament
b) Multifilament
5) ELASTICITY- the degree of suture stretches
and return to original length.
6) MEMORY or SUTURE STIFFNESS-
high memory : mean suture stiffness, difficult
to handle with, unties.
7) TISSUE REACTIVITY- peak of inflammatory
reaction in the first 2-7 days.

5.  Can be used in any tissue
 Easy to handle
 Good knot security
 Minimal tissue reaction

6.  Unfriendly to bacteria
 Strong yet small
 Won’t tear through tissues
 Cheap

7.  1) Absorbable and Non Absorbable
 2) Monofilament and Multifilament
 3) Natural and Synthetic

8. 1.Can be defined as the
suture that loses
tensile strength within
2 months.
2.It undergoes
enzymatic or hydrolytic
degradation.
3.Usually elicit marked
inflammatory reaction.
1.It’s effective tensile
strength remain for
several months.
2.It has reduce or absent
degradation.
3.Usually it is inert with
minimal tissue
reaction.

9.  memory easy to handle
 less tissue drag more tissue drag
 doesn’t wick wicks/ bacteria
 poor knot security good knot security
 - tissue reaction +tissue reaction

10. 1) natural – gut
chromic catgut
collagen
2) Synthetic – polyglactin (vicryl)
polyglycolic (dexon)
polydiaxanon(pds)
polytrimethylene carbonate
(maxon)

11.  Natural:
◦ Gut
◦ Chromic Gut
◦ Collagen
 All are absorbable

12.  Made of submucosa of small intestines of sheep
and cats.
 Multifilament
 Breaks down by phagocytosis: inflammatory
reaction common

13. Natural sutures
Very reactive, absorbable
Derived from flexor tendon of beef.
More consistent in strength and smoother than
gut sutures.
.

14. A) POLYGLACTIN 910(VICRYL)—
1) Made from polyglycolic acid+ lactic acid.
2) Available in monofilament and braided
multifilament.
3)Coated vicryl( or vicryl plus) is covered with
polyglactin 370+ calcium stearate( the coat-
-ing make the suture smoother and softer thus
less tissue drag).

15.  Tensile strength: 2-3 weeks.
 Complete absorption occur after 2-3 months
 Undergoes hydrolytic degradation.
 It is commonly used in strabismus surgery
and conjunctival closure.

16.  Polymer of glycolic acids.
 Braided, synthetic, absorbable
 Broken down by enzymes.
 Both PGA and dexon have increased tissue drag,
good knot security.
 They are stronger than gut.

17.  Mono or braided multifilament made from
polyester and polydiaxanon.
 PDS is ideal for internal tissue whenever long
lasting absorption is required.
 Tensile strength- 4-6 months.
 Complete absorption occur after 6 months.

18.  It is stronger than PDS and better knot tying
than vicryl.
 Tensile strength- 4- 6 weeks.

19.  1) SILK
 2) POLYAMIDE ( NYLON) ( ETHILON)
 3)POLYPROPYLENE( PROLENE)
 4) POLYESTER

20.  Derived from spider cocoon.
 Tensile strength: 3-6 month.
 Complete absorption may occur after several
years but still considered as non-absorbable.

21. 1)It is the commonest suture used in microsur-
gery because of its consistent tensile strength
,smooth and even surface and good knotting
property.
2) It is relatively elastic with stiff end, that’s
why the knot must be burried.
3) Monofilament made from polyamide.
4) It loses 10-15% of its tensile strength.

22.  It is the most elastic monofilament with very
stiff end.
 It retain tensile strength over 2 years.
 Inert and less tissue reaction.
 It has non-hydrolytic , so not affected by
body fluid
 Useful for suturing non-healing wound e.g.
iris wound, intraocular lens to iris fixation.

23.  It is the strongest and least elastic suture that
has permanent tensile strength, that’s why
commonly used in retinal surgery.

24.  The size of suture refer to the diameter of
suture strand and this can be measured by
two ways—
1)Usp : adopted by united state pharmacopia,
in which the diameter denoted as zero.
The more zero, the smaller is the size of
suture.
2) Metric measurement : it is the newest and
adopted by European and USP,in which the
suture diameter measured in mm.

27. A. Points of needle:
1. Cutting points : it used to penetrate when
tissue is difficult to be penetrated as skin
and tendon
2. Reverse cutting
3. Taper point : these needles are used in soft
tissue such as intestine and peritoneum,
the sharp point at the tip of needie
4. Blunt point : thses are using for suturing
friable tissue such as liver and kidney

28. 1)Cutting-
Cutting edge on inside
of circle
Skin
Traumatic

29. 2)Reverse Cutting
 Cutting edge on outside of circle.
 Skin
 Less traumatic than cutting.

30. B. Body of needle :
1.Straight 2.curved
C.eyed of needle:the eye is the segment of
needle where the suture strand is attached
1.Eyed needle : like of any household sewing
needle.
2. Frensh eye needle: it has a slit from the inside
if the eye to the end of the needle through
which the suture is drawn.
3.Eyeless needle : the suture strand and the
needle are one unit.

32.  1) CS-ULTIMA*Spatula needle-
its concave spatula geometry requires less
force to penetrate corneal scleral tissue,so
less post operative astigmatism.
2) ADVANCED MICRO-POINT* Spatula needle-
the sharp cutting point has been merged into
a square shape body to produce good penetr-
-ation characteristics. And also square shape
body increases resistance to bending,thus
gives good needle holder security.

35. THANK YOU