This document discusses different types of suture materials used in surgery. It defines sutures as stitches used to approximate the edges of a surgical or traumatic wound. The goals of suturing are to provide adequate tension, maintain hemostasis, support tissue margins, reduce post-op pain, and prevent bone exposure. Sutures are classified based on their source, fate, and structure. Both absorbable and non-absorbable, natural and synthetic suture materials are described, along with their properties, advantages, disadvantages and common uses. The key principles of suture selection are matching the material to the tissue, wound conditions, and patient factors.

1. SUTURE MATERIALS
“I dress the wound, God heals it.”
Ambroise Pare
Surgeon 16th century
Dr Shubhrendu
ENT Surgeon

2. • Suture is a Stitch/Series of stitches made to
secure apposition of the edges of a
Surgical/Traumatic wound (Wilkins)
DEFINITION

3. • Provide adequate tension
• Maintain hemostasis
• Provide support for tissue margins
• Reduce post-op pain
• Prevent bone exposure
• Permit proper flap position
GOALS OF SUTURING

4. • BASED ON THE SOURCE
• NATURAL
• ARTIFICIAL
• BASED ON THE FATE
• ABSORBABLE
• NON-ABSORBABLE
• BASED ON THE STRUCTURE
• MONOFILAMENT
• MULTIFILAMENT
CLASSIFICATION

5. • ABSORBABLE
– Catgut
– Chromic catgut
– Collagen
– Fascia lata
– kangaroo tendon
– Beef tendon
– Cargile membrane
• NON-ABSORBABLE
– Silk
– Silk worm gut
– Linen
– Cotton
– Ramie Horse hair
NATURAL

6. SYNTHETIC
Polyglycolic Acid
Polyglactic Acid
Polyglactin 910(Vicryl)
Polydioxanone(PDS)
Polyglecaprone 25
Nylon/ polyamide
PolyPropylene
Polyesters
Polyethelene
Polybutester
Polyvinylidene fluoride /
PVDF Sutures
• ABSORBABLE • NON ABSORBABLE

7. MONOFILAMENT
Plain, Chromic catgut
Polydiaxanone
Polyglactin 910
Polypropylene
Polyester
Nylon/polyamide
Polyvinylidene fluoride /
PVDF Sutures
• ABSORBABLE • NON ABSORBABLE

8. MULTIFILAMENT
Polyglactin 910
Polyglycolic Acid
• Silk
• Cotton
• Linen
• ABSORBABLE • NON-ABSORBABLE

9.  Advantages
– Smooth surface
– Less tissue trauma
– No bacterial harbours
– No capillarity
 Disadvantages
– Handling and knotting
– Stretch
– Any nick or crimp in the material leads to breakage
MONOFILAMENT

10. Advantages
• Strength
• Soft and pliable
• Good handling
• Good knotting
Disadvantages
• Bacterial harbours
• Capillary action
• Tissue trauma
MULTIFILAMENT

11. • The selection of suture material by a surgeon must be
based on a sound knowledge of
– Healing characteristics of the tissues which are to be
approximated
– The physical and biological properties of the suture
materials
– The condition of the wound to be closed
– The probable post-operative course of the patient.
Principles of suture selection

12. • MONOFILAMENT
• ABSORBABLE
• Absorption :40-60 days
NATURAL CATGUT

13. • Coated with thin layer of chromium salt solution to
minimize tissue reaction, increase TS, slow the
absorption rate, better knot security, and ease of
handling.
• TS – 10-14 days
• Absorbed in 90 days
• Uses:Ophthalmic surgery (6-0) Oral surgery Suture
subcutaneous tissues
CHROMIC CATGUT

14. • Coated and uncoated
• Synthetic absorbable suture
• Monofilament/multifilament
• Lactide has hydrophobic qualities→delaying loss of TS
• TS - 14 – 21 days.
• Absorption – 56-70 days.
• Minimal tissue reactivity and can be used in infected tissues
• Available in purple and undyed. Undyed used on face
POLYGLACTIN 910 (VICRYL)

15. • Synthetic,absorbable,monofilament
• TS -14-42 days
• Absorption – Hydrolysis in 6 months.
• Passes through tissues easily.
• Significant memory – compromises the ease of knot-
tying and knot security.
• Minimal tissue reaction
• For wounds under tension and contaminated wounds.
• May extrude through the wound over time. So used
only in tissues deeper than subcuticular layer. Or if in
face 6- 0 used.
POLYDIOXANONE (PDS II)

16. • NATURAL NON-ABSORBABLE
• Advantage:
– Ease of handling – more for braided
– Good knot security
– Cost effective
– Contraindications: Should not be used in presence of
infection
 Uses: Plastic surgery, ophthalmic and general
surgeries, ligating body tissues.
SURGICAL SILK

17. • Synthetic non absorbable
• Inert and TS for 2 yrs
• Holds knots better than other synthetic sutures.
• Advantages -Minimal suture reaction and so
used in infected and contaminated wounds.
• Uses : General, plastic, cardiovascular surgery,
skin closure, ophthalmology.
POLYPROPYLENE (PROLENE)

18. • Uncoated, but inert and non irritating to the
tissues.
• High TS and low tissue reactivity .
• Some memory and return to original linear shape
over time. Because of this more throws (4
throws) indicated.
• Uses: Skin closure, retention, plastic, ophthalmic
and microsurgery.
NYLON MONOFILAMENT (DERMALON,
ETHILON)

19. • Absorbable, synthetic, monofilament
• Hydrolysis 90-120 days
• Advantages
– Tissue reaction – minimal
– Good knot strength
– Used for soft tissue closure
– Most pliable material ever made
MONOCRYL