Suture and suture material- Absorable Suture and Non-Absorable Suture Material in Details with suture Name Made By Sonal Patel

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JG COLLEGE OF NURSING,
AHMEDABAD.
SUBJECT: OBSTETRIC AND GYNECOLOGICAL
NURSING-II
TOPIC : CLINICAL TEACHING
SUBMITTED TO: SUBMITTEDBY:
MS. REKHAMOL SIDHANAR, PATEL SONAL P.

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ASSISTANT PROESSOR, s.Y M.SC NURSING, J.G COLLEGE
OF NURSING J.G COLLEGE OF NURSING
AHMEDABAD. AHMEDABAD.
Suture and suture material
Introduction:
 Suture also known as stitches, a piece of thread like material use to secure
wound edges or body parts together after an injury or surgery. A variety of
suture exists in size strength and durability.
1. ABSORBABLE
SYNTHEITC NATURAL
MULTIFILAMENT MONOFILAMENT MULTIFILAMENT MONOFILAMENT
POLYGLYCOLIC PDS CATGUT
ACID POLYGLY- COLLAGEN
POLYGLACTIN CONATE
2. NONABSORBABLE
SYNTHEITC NATURAL

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MULTIFILAMENT MONOFILAMENT MULTIFILAMENT MONOFILAMENT
NYLON NYLON SILK
POLYESTER POLYETHYLENE LINEN
STAINLESS POLYBUTESTER COTTON
STEEL POLYPROPYLENE METAL WIRE
STAINLESS STEEL
1. Absorbable Sutures
Absorbable sutures are dissolved by the body's tissues. The great advantage is that the sutures
do not need to be removed. However, absorbable sutures tend to leave a more pronounced scar
when used as skin sutures. Absorbable sutures are primarily used under the skin, where they
are well hidden. It is sometimes difficult to get patients to return for suture removal. If this is a
concern, use an absorbable suture for skin closure. You should warn the patient that absorbable
sutures probably will result in a more noticeable scar than nonabsorbable sutures with later
removal. Because it is often difficult to remove stitches from children (because of their crying
and difficulty in staying still), absorbable materials should be used when suturing their wounds.
a. Absorbable Sutures
 Polyglycolic Acid Sutures (Dexon)
 Polyglactin 910 Sutures (Vicryl)
 Catgut Sutures
 Poliglecaprone Sutures
 Polydioxanone Sutures (PDS)
2. Nonabsorbable Sutures
Nonabsorbable sutures remain in place until they are removed. Because they are not dissolved
by the body, they are less tissue-reactive and therefore leave less scarring as long as they are
removed in a timely fashion. They are best used on the skin.
b. Non-absorbable Sutures
 Polypropylene Sutures (Prolene,Prodek, Surgilence)
 Polyamide / Nylon Sutures
 Polyester Sutures (Dacron, Ticron, Polydek)
 Silk Sutures

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 Polyvinylidene fluoride / PVDF Sutures
 Stainless Steel Sutures
Braided/ multifilament Sutures
Braided sutures are made up of several thin strands of the suture material twisted together.
Braided sutures are easier to tie than nonbraided sutures. However, braided sutures have little
interstices in the suture material, which can be a place for bacteria to hide and grow, resulting
in an increased risk of infection.
Multifilament or braided sutures include :-
 PGA sutures,
 Polyglactin 910,
 silk and polyester sutures.
Nonbraided/ monofilament Sutures
Nonbraided sutures are simply a monofilament, a single strand. They are not made up of the
little subunits found in a braided suture. Nonbraided sutures are recommended for most skin
closures, especially wounds that may be at risk for infection.
Monofilament sutures include :-
 Polypropylene sutures,
 Catgut,
 Nylon,
 PVDF,
 Stainless steel,
 Poliglecaprone and
 Polydioxanone sutures.
How sutures are made:
 Sutures are made from both man-made and natural materials. Natural suture materials include
silk, linen, and catgut, which is actually the dried and treated intestine of a cow or sheep.
 Synthetic sutures are made from a variety of textiles such as nylon or polyester, formulated
specifically for surgical use. Absorbable synthetic sutures are made from polyglycolic acid or
other glycolide polymers.

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 Most of the synthetic suture materials have proprietary names, such as Dexon and Vicryl. The
water-resistant material Goretex has been used for surgical sutures, and other sutures are
made from thin metal wire.
 Natural sutures are made of catgut or reconstituted collagen, or from cotton, silk, or linen.
Synthetic absorbable sutures may be made of polyglycolic acid, a glycolide-lactide copolymer;
or polydioxanone, a copolymer of glycolide and trimethylene carbonate.
 These different polymers are marketed under specific trade names. Synthetic nonabsorbable
sutures may be made of polypropylene, polyester, polyethylene terephthalate, polybutylene
terephthalate, polyamide, different proprietary nylons, or Goretex. Some sutures are also made
of stainless steel.
 Sutures are often coated, especially braided or twisted sutures. They may also be dyed to make
them easy to see during surgery. Only FDA approved dyes and coatings may be used.
 Some allowable dyes are: logwood extract, chromium-cobalt-aluminum oxide, ferric
ammonium citrate pyrogallol, D&C Blue No. 9, D&C Blue No. 6, D&C Green No. 5, and D&C
Green No. 6. The coatings used depend on whether the suture is absorbable or nonabsorbable.
 Absorbable coatings include Poloxamer 188 and calcium stearate with a glycolide-lactide
copolymer. Nonabsorbable sutures may be coated with wax, silicone, fluorocarbon, or
polytetramethylene adipate.
Suture Size
In the United States, suture diameter is represented on a scale descending from 10 to 1, and then
descending again from 1-0 to 12-0. Number 9 sutures is 0.0012 in (0.03 mm) in diameter, while
the smallest, number 12-0, is smaller in diameter than a human hair.
The size of suture material is measured by its width or diameter and is vital to proper wound
closure. As a guide the following are specific areas of their usage:
 1-0 and 2-0: Used for high stress areas requiring strong retention, i.e. deep fascia
repair
 3-0: Used in areas requiring good retention, i.e. – scalp, torso, and hands
 4-0: Used in areas requiring minimal retention, i.e. – extremities. Is the most
common size utilized for superficial wound closure.
 5-0: Used for areas involving the face, nose, ears, eyebrows, and eyelids.

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 6-0: Used on areas requiring little or no retention. Primarily used for cosmetic
effects.
Natural Suture Materials
Natural sutures are made from natural materials such as collagen derived from the
gastrointestinal track of animals, woven cotton, raw silk, linen, or steel. Because of the material,
tissue reaction is often greater with natural sutures, especially those that are absorbable (e.g.
Catgut). Coating agents are often used to help reduce tissue reactivity and to help reduce friction.
Natural Non-Absorbable Sutures
Suture Material Silk Surgical Steel
Description
Silksuture isa non-absorbable,sterile,surgical suture composedof an
organicproteincalledfibroin. silksuturesare processedtoremove the
Surgical Steel sutures
are non-absorbable,
Natural Absorbable Sutures
Suture
Material
Plain Catgut Chromic Catgut
Description
PlainCatgutsuture isan absorbable,sterile,
surgical suture composedof highlypurified
connective tissue(mostlycollagen) derivedfrom
eitherbeef orsheepintestines.
ChromicCatgut istreatedwithchromium
saltsolutiontoresistbodyenzymes,
therebyprolongingthe absorptiontime
to over90 days.
Tissue
reaction
Moderate Moderate
Tensile
strength
Maintainsstrengthfor7-10 days Maintainsstrengthfor10-14 days
Degradation Enzymatic Enzymatic

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natural waxesandgums fromitsorigin. sterile,surgical
suturescomposedof
highqualitystainless
steel.
Tissue reaction Moderate Moderate
Tensile strength
Srengthdecreasesasmoisture isabsorbedandiscompletelylostwithin
1 year.
Minimal lossover
time
Degradation None None
SyntheticSutureMaterials
Synthetic sutures are made from synthetic collagen derived from polymers. Synthetic sutures are
broken down by hydrolysis as opposite to enzymatic degradation (natural sutures), causing less
tissue reaction.
Synthetic Absorbable Sutures
Suture
Material
Polyglycolic Acid Polyglactin 910 Polydioxanone
Description
PolyglycolicAcid
suture isa synthetic,
absorbable,sterile,
surgical suture
composedof 100%
glycolide.
Polyglactin 910 suture isa
synthetic,absorbable,
sterile,surgical suture
composedof copolymers
made from90% glycolide
and 10% L-lactide.
Polydioxanonesuture isanabsorbable,
sterile,surgical suture composedof the
polyesterpoly(p-dioxanone).
Polydioxanonehasbeenfoundtobe
nonantigenic,nonpyrogenic,andelicitsonly
minimal tissue reactivityduringthe
absorptionprocess.
Tissue
reaction
Mild Mild Minimal
Tensile 84% at 2 weeks,23% 74% at 2 weeks,18% at 4 80% at 2 weeks,44% at 8 weeks.Complete

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strength at 4 weeks. weeks. absorptionwithin200 days.
Degradation Hydrolysis Hydrolysis Hydrolysis
Synthetic Non-Absorbable Sutures
Suture
Material
Polyester Nylon Polypropylene
Description
Polyestersuture isanon-
absorbable,sterile,surgical suture
composedof Poly(ethylene
terephthalate). uniformlycoats
itsPolyestersutures,providingfor
an improvementinthe physical
propertiesof the suture.High
qualitymaterials,combinedwith
precise braidingmechanisms,
nearlyeliminate the occurrence of
post-operative suture fragments
inthe tissue.
Nylonsuture isa non-
absorbable,sterile surgical
suture composedof the
longchainaliphatic
polymersNylon6and
Nylon6.6. Nylonsutures
are available ineitherblack
or blue,dyedwithFDA
listeddye(s). Nylonsutures
elicitminimalinflammatory
reactionintissue.
Polypropylenesuture isanon-
absorbable,sterile surgical suture
composedof a syntheticlinear
polyolefin. Polypropylene suture
elicitsaminimal acute
inflammatoryreactioninthe
tissue,followedbygradual
encapsulationof the suture by
fibroustissue.Due toits
monofilamentcomposure,
Polypropylenesuture resists
involvementininfection.
Moreover,Polypropylene has
beensuccessfullyimplementedin
contaminatedandpreviously
infectedwounds.
Tissue
reaction
Minimal Minimal Minimal
Tensile Notknownto lose tensile strength Progressive hydrolysismay Maintainstensile strengthupto

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strength invivo. cause lossin tensile
strengthupto 20% per
year.
twoyears.
Degradation None None None
Needles:
Surgery requires the use of several different types of needles. Needles need to be strong enough
to pass through tough tissue while causing minimal trauma to delicate tissues and reducing tissue
reactions. Needles are made of steel, come in different sizes, have blunt or sharp points, and can
be curved or straight.
1. Straight Needles
 Straight needles are used for skin closure in some surgeries. Straight needles can be used for
suturing without requiring the use of a needle holder, as long as the suturing area offers good
visibility.
2. Curved Needles
 Curved needles are the most commonly used surgical needles. Curved needles are made in
several different configurations, including half-curved (previously used for skin closure but
rarely used today);
 1/4-circle, used for microsurgery and ocular procedures;
 3/8-, 1/2- and 5/8-circle, used for cardiovascular surgery, oral and nasal surgery; and
compound curved needles.
 Curved needles of 3/8- or 1/2-circle are used for skin closure and gastrointestinal,
genitourinary and respiratory surgeries.
 Compound curved needles, which have a have a straight point with a curved distal section, are
used for ophthalmological procedures as well as oral, plastic and vascular surgeries.
3. Cutting Needles
 Cutting needles have sharp points and edges so they can penetrate tough skin easily; they
typically have three cutting edges. One type called reverse cutting needle, causes less trauma
to tissue and are used for ophthalmic and plastic surgery .

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 Another type, taper cut needles, are used on tough tissue such as connective tissue. Side
cutting or speculate needles can have up to four sides and are used for ophthalmic surgery.
Suture Attachment
Suture is attached to most surgical needles today by bonding, a type of connection known as
eyeless, or swaged. Closed-eye needles need to have suture tied through the eye, making them
more bulky. French-eye needles are slitted, so that suture can be slid onto the needle.
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