Classification of Sutures and the Uses presented in March 2012

1. SURGICAL SUTURES
Dr. PRADEEP
CRRI
KMCH SURGERY II
March 2012

2. DEFINITION
• Suturing is the joining of tissues
with needle and “thread,” so that
the tissues bind together and heal.
• SPECIALIZED THREAD - SUTURE
MATERIAL
– THREADS on which life may depend.
• Foreign body reaction.

3. HISTORY
• Oldest suture is in a mummy 1100BC
• 500 BC- suture materials and usage – sushruta
• Africans – thorns and ant sutures by coaxing
insects to bite wound edges with their jaws and
subsequently twisting off the insects' heads.
• Roman physician galen – describe gut
• Surgeon Al-zahrawi – reported dissolving nature
of catgut.
• Joseph lister – sterilisation . Sterile catgut in
1906 by iodine treatment.

4. CLASSIFICATION
SUTURES
Absorbable
Natural
Synthetic
Non
Absorbable
Natural
Metallic
Synthetic
Sutures
Monofilament
Multifilament

5. ABSORBABLE SUTURES
• U.S.P. – ‘Sterile strand prepared from
collagen derived from healthy mammals or
synthetic polymer.
• Natural – cellular and tissue proteases digest
• Synthetic – hydrolysis in tissue fluids
• ADVANTAGES:
• No foreign body left
• No stone formation
• Quickly heal tissues

6. NON ABSORBABLE SUTURES
• Sterile strands of material that are suitably
resistant to the action of living mammalian tissue.
• ADVANTAGES:
• High tensile strength
• Used for wound closure, CVS surgeries, Hernia
repairs

7. MULTI MONO

8. NATURAL AND SYNTHETIC
• Natural – Proteins , tissue enzyme digestion
• Synthetic – Carbohydrates, Hydrolysis.
• Eliminates allergic reaction
• Twice as strong as natural
• Lose the tensile strength slowly
• Predictable absorption.
• Excellent handling characterisitics
• Sterilized by Ethylene oxide. Shelf life 5 years

9. SUTURE TYPE ABSORBABLE NON ABSORBABLE
MONOFILAMENT Surgical gut Plain, chromic
Collagen – plain, chromic
Polyglecaprone 25
Polydiaxanone
Polyamide
Polypropylene
Stainless steel
Polyester
MULTIFILAMENT Polyglycolic acid
Coated Polyglactin 910
Coated Polyglactin 910 with
antibacterial agent
Coated Polyglactin 910
RAPIDE
Surgical silk
Surgical Linen
Cotton
Polyamide Braided
Polyester Braided
Polyester Braided coated
Stainless steel

11. SURGICAL GUT
• 99% pure collagen
• Submucosa of sheep intestine and
serosa of beef intestines
• Monofilament
• Enzymatic degradation
• Complete absorption by 60-90 days
• Sterilisation by gamma irrad 2.5 Mrad
• Tensile strength loss is faster than
absorption

12. PLAIN AND CHROMIC
• Plain – 7-10 days maintains tensile strength
• Chromic – 10 -14 days.
• Y CHROMIC???
• WET PACKING???
• Sizes 5-0 to 2.
• Not to be usd in infected wounds.
PLAIN ( YELLOW ) CHROMIC ( BROWN )
Bleeders
Subcut sutures
Circumcision
Wounds in LIP
Approx of muscles,
peritoneum closure, bowel
anastomoses, all OG
procedures.

13. POLYGLYCOLIC ACID
• Polymers of glycolic acid. 100%
• Coated with Polycaprolactone &
Calcium stearate(Why?).
• Absp time – 60 -90 days
• Minimal tissue reactions
• Retains 75% tensile strength after 2 weeks
• General soft tissue approximation , ophthalmic
• Violet and undyed . Sizes 6-0 to USP 2.

14. POLYGLACTIN 910
• Copolymers 90% glycolide and 10%
L-lactide.
• Braided – easy handling and
knotting.
• Plain and coated
• COATING – calcium stearate.
Absorbable adherent, non flaking
lubricant – low tissue drag, reduces
surface friction of braid.

15. VICRYL
• Retains 70% tensile strength by 2 weeks.
• Non antigenic/pyrogenic
• Minimal tissue reaction.
• Soft tissue approximation and Ligation.
• Violet and undyed.
• 910 - ?

16. VICRYL PLUS AND RAPIDE
• PLUS - Antimicrobial TRICLOSAN – combat
surface skin infections
• CI – ophthalmic, cvs and neural tissues.
• RAPIDE – by gamma irrad of coated vicryl
• Low molecular weight
• Initially tensile strength 30%less
• Lose al its strength b/w 10th and 12th day
• Totally absorbed in 42 days.
• CIRCUMCISION – excellent cosmesis.
• Beige and undyed.

17. POLYGLECAPRONE 25
• Monofilament ( MONOCRYL )
• 75% glycolide, 25% caprolactone
• Very High initial tensile strength
• Most pliable, very smooth, knot security
• No PACKAGE MEMORY
• Loses 40% tensile strength in 1- 2 weeks,
60 – 70% in 4 weeks
• Completely hydrolyzed in 3 months
• Bowel anastomoses, peritoneal closure,
subcut, subcuticular, Urology.
• Violet and undyed.

18. POLYDIOXANONE
• Poly(ether-ester) Poly p-dioxanone.
• Strongest Monofilament 20 -30%
• Inert, predictable absorption.
• Smooth , pliable, minimal package memory
• Retain 80% TS after 2 wks, 50% 4 wks.
• Total absorption 6 – 7 months
• Orthopaedic, Paed CVS, general, subcuticular and
fascia closure.
• Dyed dark blue

19. SURGICAL SILK
• Non absorbable, multifilament , natural – fibroin.
• From cocoon of silk larvae.(Bombyx mori)
• Braided and treated with silicone or wax
• High tensile strength
• Maximal tissue reaction, encapsulation 2-3w
• Sterilisation gamma irrad.
• General closure, G. I. Tract, Plastic, Skin, Opthalmic,
Cardiovascular Surgeries. Widely used as ligature.
• CI – urinary & biliary tract. Infection.
• Black , sizes 5-0 to USP 2.

20. POLYAMIDES - NYLON
• Monofilament, smooth soft
• Very minimal tissue reaction
• Lose 25% tensile strength aft 1 yr
• Package memory present
• Excellent knot security and no
tissue adherence
• Blue/black , sizes 10-0 to USP 2.

21. POLYESTERS
• Terylene and dacron
• High tensile strength
• No/minimal tissue reaction
• Tensile strength retained indefinitely
• CVS surgeries
• Coated with teflon to prevent cut through –
cause flaking, Increase diameter of suture mat

22. POLYPROPYLENE (prolene)
• Monofilament, synthetic, smooth
• Extremely high tensile strength
• Retains it indefinitely
• No tissue reaction
• Extend upto 30% before breaking – so
useful where post-op give up is
required – prevent tissue
strangulation.
• Blue. Sizes 8-0 to USP 1.

23. STAINLESS STEEL
• Non absorbable
• Monofilament, strength, Inert
• Composed of 316L stainless steel
• Sizes 5-0 to 6
• Abdominal wound closure, hernia repair, sternal
closure and orthopaedic procedures including
tendon repair.
• Sternal bands – highly stable and promote faster
healing.

24. SUTURE SELECTION
• Healing rates of various tissues
• Strength of the material
• Rate of absorption
• Cosmesis
• Tissue contamination
• Nourishment
• Cancer pts depending on the time of irrad
Rx. Before irrad – Polyester should be
used.
• After – Prolene ideal, No
tension/mattress.

25. • Wound gains strength after 6 days, so suture
must be strong enough to hold tissues in
proper apposition during 1st week.
• When it has reached max. strength – no
longer sutures needed.

26. IDEAL
• Skin, fasica, tendons, abdominal incision
closure – Nonabsorbable
• Peritoneum, liver, small intestine, stomach,
colon, bladder, muscles – Absorbable.
• Tissue contaminated – Prolene. Avoid multi.
• Biliary and urinary tract- absorbable . Non
absorbable not to be used even on outer
surface.
• Pancreatic – vicryl, prolene. Gut avoided.

27. SIZES
• Peritoneum 2-0/3-0
• Muscles 1-0 / 1
• Linea alba 1
• Rectus sheath 1-0/1
• Subcut 3-0
• Eso/stomach/SI/colon – 2-0/3-0
• Kidney 1-0
• Bladder 2-0
• OBG 1-0/1
• Ovarian 2-0/3-0
• Hernia 1-0/1
• Tendons 4-0/5-0
• Ophthalmic 8-0 to 10-0
• Face 5-0/6-0
• Hands and limbs 3-0/4-0

28. SUTURE BOX
• The United State Pharmacopoeia (USP) recommends that
suture boxes must provide complete information of the
suture materials. This includes:
1. size
2. types of sutures
3. types of needles
• Some boxes have
specific indications, like
– F S ……….. for skin
– P S ……….. for plastic skin
– P ……….. for precision point
– P C…….…. Precision cosmetic