The document discusses sutures, detailing their definitions, properties, classifications, and comparisons between absorbable and non-absorbable sutures. It outlines the characteristics of ideal sutures, their types (natural and synthetic), and the benefits and drawbacks of monofilament versus multifilament strands. Additionally, the document includes guidelines for suture selection based on body region and provides recommended intervals for suture removal.

1. Prepared by : ARFAN AHMED SHOUROV
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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2. Tools:
1. Needle
2. Suture material
The Suture
The word "suture" describes any strand of
material used to ligate (tie) blood vessels or
approximate (bring close together) tissues.
Sutures are used to close wounds.
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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3. Properties of Suture Material…
Properties
Physical
Tensile Strength,
Dimension, Knot-pull
strength, Knot security,
Stiffness
Handling
Knot-tie down, First
throw hold, Tissue
drag, Package
memory, Suppleness
Biological
Tissue reaction,
Absorption,
Biocompatibility,
Tensile strength loss
All standards, test procedures and product specifications are set by U.S.
Pharmacopeia (U.S.P.)
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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4. Characteristics of an Ideal Suture
Usable in any procedure
Inert (minimum tissue reaction), disappears after the wound is
healed
Easy to handle, pliable, high knot security
Predictable performance
Uniform tensile strength and tensile retention
Sterile, no capillarity
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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5. Suture classification
AAbbssoorrbbaabbllee NNoonn--AAbbssoorrbbaabbllee
NNaattuurraall Synthetic NNaattuurraall Synthetic
MMoonnooffiillaammeenntt MMuullttiiffiillaammeenntt
Short-Medium
-term
Medium
-term
Longer
-term
MMoonnooffiillaammeenntt MMuullttiiffiillaammeenntt
Short
-term
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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6. Classifying Suture Material…
Suture Types Generic Structure Classification
Catgut Collagen from animal intestines Natural, absorbable, twisted multifilament
(mono.)
Silk Fibroin from silkworm Bombyx mori Natural, non-absorbable, braid
multifilament
Polypropylene Isotactic crystalline stereoisomer of
PP
Synthetic, non-absorbable, monofilament
Polyamide Nylon 6 and nylon 6,6 Synthetic, non-absorbable, monofilament
Stainless steel 316L (low carbon) stainless steel alloy Metal, non-absorbable, mono and
multifilament
Polyglycolic acid/
Polylactic acid
90% PGA, 10% PLA Synthetic, absorbable, braided
multifilament
Polydioxanone Polyester p-dioxanone Synthetic, absorbable, monofilament
Polyglycolic acid/
Copolymer of glycolic acid and
Synthetic, absorbable, monofilament
Polytrimethylene
trimethylene carbonate
carbonate
Source: Ratner et al. 2004
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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7. Classifying Suture Material…
Fiber construction
Source: Suture Technical Specifications, Demetech (http://www.demetech.us/suture-specs.php)
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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8. MONOFILAMENT VS. MULTIFILAMENT STRANDS
 single strand of material
 encounter less resistance as
they pass through tissue (Tissue
Drag )
 well-suited to vascular surgery
 tie down easily
Crushing or crimping can create
a weak spot in the strand
 minimize scarring
 several filaments, or strands,
twisted or braided together
 affords greater tensile
strength, pliability, and flexibility
 coated to help them pass
relatively smoothly through tissue
and enhance handling
characteristics
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9. MONOFILAMENT VS. MULTIFILAMENT STRANDS
• Minimal tissue trauma
• Smooth tying but more knots
needed
• Harder to handle
• Occur irritant (if present for a long
time).
• Examples: nylon, monocryl, prolene,
• Easier to handle
• Fewer knots needed
• Examples: vicryl, silk,
chromic
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10. Disadvantages of Braided Sutures
 Risk of Infection: braided suture can serve as bacteria U2
harboring
zones, allowing bacteria to colonize and multiply.
Increased Tissue Drag - Their braided structure has a rougher
surface than that of a monofilament.
This results in increased tissue drag, which can cause irritation, and
a certain amount of tissue damage depending on suture technique.
Increased tissue trauma is a risk factor for infection.
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11. Slide 10
U2 interstices serve as highways over which bacteria can travel; This movement of bacteria along the suture line is called capillarity.
User, 4/8/2014
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12. In order to minimize scarring,
a monofilament suture such as DemeCAPRONE (poliglecaprone 25)
Suture might be chosen over a braided suture such as
DemeCRYL* (polyglactin 910)
a monofilament suture is that its smooth surface reduces the
chance of harboring bacteria.
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13. ABSORBABLE SUTURES vs NONABSORBABLE SUTURES
Sutures that undergo rapid
degradation in tissues, losing their
tensile strength within 60 days, are
considered absorbable sutures.
digested by body enzymes
Sutures that generally maintain
their tensile strength for longer
than 60 days are non absorbable
sutures.
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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14. MMoonnooffiillaammeenntt
Advantages
• Smooth surface
• Less tissue trauma
• No bacterial harbours
• No capillarity
Disadvantages
• Handling & knotting
• Ends/knot burial
• Stretch
MMuullttiiffiillaammeenntt
Advantages
• Strength
• Soft & pliable
• Good handling
• Good knotting
Disadvantages
• Bacterial harbours
• Capillary action
• Tissue trauma
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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15. ABSORBABLE VS. NONABSORBABLE SUTURES
From collagen of healthy
mammals or from synthetic
polymers
 absorbed rapidly
digested by body enzymes
made from nonbiodegradable
materials and encapsulated or
walled off by the body’s
fibroblasts
 not digested by body enzymes
or hydrolyzed
 must be removed
postoperatively.
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16. NONABSORBABLE SUTURES
Nonabsorbable sutures may be used in a variety of applications:
Exterior skin closure, to be removed after sufficient healing has
occurred.
Within the body cavity: where they will remain permanently
encapsulated in tissue.
Patient history of reaction to absorbable sutures, keloidal
tendency, or possible tissue hypertrophy.
Prosthesis attachment (i.e., defibrillators, pacemakers, drug
delivery mechanisms).
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17. NNoonn--aabbssoorrbbaabbllee
• Not biodegradable
and permanent
– Nylon
– Prolene
– Stainless steel
– Silk (natural, can
break down over
years)
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18. AAbbssoorrbbaabbllee
• Degraded via
inflammatory
response
– Vicryl
– Monocryl
– Chromic
– Cat gut (natural)
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19. NNaattuurraall SSuuttuurree
• Biological
• Cause inflammatory
reaction
– Catgut (connective from
cow or sheep)
– Silk (from silkworm fibers)
– outer intestinal lining
(serosa) of cattle
– Chromic catgut
Synthetic
• Synthetic polymers
• Do not cause
inflammatory response
– Nylon
– Vicryl
– Monocryl
– Prolene
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20. SSyynntthheettiicc
Advantages
Non-Absorbables are inert
• Absorbables resemble natural
substances
• Absorption by hydrolysis
• Predictable absorption
• Strength
Disadvantages
Monofilament
handling
BBiioollooggiiccaall
Advantages
• Handling & knotting
Disadvantages
• Tissue reactions
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21. Advantages
• Broken down by body
• No foreign body left
Disadvantages
• Consideration of
wound support time
NNoonn -- AAbbssoorrbbaabbllee
Advantages
Permanent wound Support
Disadvantages
Foreign body left
Suture removal can be costly and
inconvenient
Sinus & Extrusion if left in place
AAbbssoorrbbaabbllee
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22. Suture Selection
Absorbable for
 GI
 Urinary
 biliary
Non-absorbable (up to 6 mos) for
 Skin
 Tendons
 fascia
• Cosmetics = monofilament or subcuticular
• Ligatures usually absorbable
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23. Suture Size
Smallest
10-0 used in the most delicate surgeries. Common in both Ophthalmic (eye)
9-0 surgery and for repairing small damaged nerves
8-0 hand.
7-0 repairing small vessels and arteries or for delicate facial plastic surgery
6-0 vascular graft sewing such a carotid endarterectomy
5-0 larger vessel repair (Abdominal Aortic Aneurysm)
4-0 skin closure
3-0 Skin closure when there is a lot of tension on the tissue, closure of muscle layers
2-0 repair of bowel in general surgery.
0 closing of the fascia layer in abdominal surgery, the joint capsule in knee
1 hip surgery or deep layers in back surgery.
2 repair of tendons or other high tension structures in large orthopedic
Largest
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24. Suggested Guidelines for Suture Material and Size for Body Region:
Scalp (skin): 5-0/4-0 Monofilament Deep (dermal): 4-0 Absorbable
Ear Percutaneous: 6-0 Monofilament
Eyelid Percutaneous: 7-0/6-0 Monofilament
Eyebrow Percutaneous: 6-0/5-0 Monofilament Deep: 5-0 Absorbable
Nose Percutaneous: 6-0 Monofilament Deep: 5-0 Absorbable
Lip Percutaneous: 6-0 Monofilament Deep: 5-0 Absorbable
Oral Mucosa Deep: 5-0 Absorbable
Face & Forehead Percutaneous: 6-0 Monofilament Deep: 5-0 Absorbable
Trunk Percutaneous: 5-0/4-0 Monofilament Deep: 3-0 Absorbable
Extremities Percutaneous: 5-0/4-0 Monofilament Deep: 4-0 Absorbable
Hand Percutaneous: 5-0 Monofilament Deep: 5-0 Absorbable
Foot/Sole Percutaneous: 4-0/3-0 Monofilament Deep: 4-0 Absorbable
Note: Percutaneous = skin; deep = dermal layer
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25. RECOMMENDED INTERVALS FOR REMOVAL OF SKIN SUTURES
Scalp 6-8 days
Face 4-5 days
Ear 4-5 days
Chest/Abdomen 8-10 days
Back 12-14 days
Arm/Leg* 8-10 days
Hand* 8-10 days
Fingertip 10-12 days
Foot 12-14 days
*Add 2 to 3 days for joint extensor surfaces.
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26. Advantages of Synthetic Sutures
 highly predictable absorption profiles
provide a wider range of absorption profiles
providing wound support for prolonged periods of time
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27. summery
Nonabsorbable Material:
Silk — has a braided structure. Easy to handle but has increased
potential for infection.
Nylon — has a monofilament structure. Commonly used in skin
closure but high degree of memory; requires several throws for secure
closure.
Polypropylene — has a monofilament structure. High degree of
memory, low tissue adhesion; good for subcuticular pull-out
technique.
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28. Advantages of Synthetic Sutures
For this reason, DemeCRYL (polyglactin 910) Suture, which
predictably maintains
75% of its tensile strength 2 weeks post implantation
50% of its tensile strength 3 weeks post implantation
25% of its tensile strength 4 weeks post implantation.
for DemeQUICK(polyglactin 910) Suture, which loses
50% of its tensile strength in 5 days,
100% of its tensile strength in 10 to 14 days
fully absorbed in 42 days.
Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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29. Date Originated: April 9,2014 | Revision No: 00 | Revision Date:
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