This document discusses different types of suture materials. It describes both absorbable and non-absorbable natural and synthetic suture materials. Absorbable sutures such as surgical gut, Monocryl, Vicryl and PDS are made from collagen or synthetic polymers and are absorbed by the body over time. Non-absorbable sutures like silk, nylon and Prolene are made from materials that resist absorption and provide long-term wound support. The document outlines the properties, characteristics and appropriate uses of various commonly used suture materials.

1. Suture material

2. • The term “ SUTURE” – describes any strand of
material utilised to ligate blood vessels or
approximate tissues during the wound healing
period
• A number of different shapes, sizes and
thread materials as well as different types of
needles have been developed over its
millennia of history.

3. • Through many millennia , various suture
materials were used, debated and remained
largely unchanged.
• Sutures were made of plant materials ( flax ,
hemp and cotton) or animal material (hair ,
tendon, muscle strips and nerves, silk, catgut)

4. THE GOALS OF SUTURING
• Provide an adequate tension of wound closure
without dead space but loose enough to
obviate tissue ischemia and necrosis
• Maintain hemostasis
• Permit primary intention healing
• Reduce postoperative pain
• Provide support for tissue margins until they
have healed

5. • Protecting underlying tissue from infection or
other irritating factors
• Permits proper flap position
• Prevent bone exposure resulting in delayed
healing and bone resorption

6. QUALITIES OF A SUTURE MATERIAL
• Adequate tensile strength
• Easy to handle
• Low cappillarity
• Flexibility and Elasticity
• Knotable
• Easily sterlisable
• Uniformity
• Smooth surface
• Non reactivity
• Absorbility

7. TYPE OF SUTURE MATERIAL

8. ACCORDING TO THEIR ORIGIN
• Organic
• Synthetic
• metallic

9. ACCORDING TO THEIR BEHAVIOUR IN
TISSUE
• Absorbable
• Non - absorbable

10. • Braided
• Non braided

11. ACCORDING TO THEIR STRUCTURE
• Monofilament
• multifilament

12. MONOFILAMENT MULTIFILAMENT
Single strand of suture material Fibers are twisted or braided together
Minimal tissue trauma More tissue resistence
Smooth tying but more knots needed Few knots needed
Harder to handle due to memory Easier to handle
Examples : nylon , monocryl , prolene , pds Examples: vicryl , silk ,chromic

13. NATURAL SYNTHETIC
Biological Synthetic polymers
Cause inflammatory reaction Less or minimal inflammatory reaction
Examples : catgut , silk Examples: nylon ,prolene

14. BRAIDED NON BRAIDED
Has capillary action No capillary action
Increased infection risk Less infection risk
Less smooth passage Smooth tissue passage
Less tensile strength Higher tensile strength
Better handling Has memory
Better knot security More knots required

15. FACTORS THAT INFLUENCE SURGEON’S
CHOICE
• Biological characteristics of the material in
tissue i.e. absorbable vs non absorbable.
• Healing characteristics of tissue
• Location and length of the incision
• Cosmetic result desired

16. Cont……..
• Presence or absence of infection
• Physical characteristics of the material :
knot tying
ease of passage through tissue
• Pts problem such as obesity , debility ,
advanced age and disease etc.

17. ABSORBABLE SUTURES
• Sterile strands prepared from collagen derived
from healthy mammals or from a synthetic
polymer
• They are capable of being absorbed or
digested by the body cells and tissue in which
they are embedded during and after the
healing process.
• Examples – surgical gut , collagen suture,
monocryl , vicryl , pds, maxon ,daxon

18. SURGICAL GUT
1 - Often referred as catgut
2 - It is derived from submucosa of sheep
intestine or serosa of beef intestine
3 - Types : (a) Plain surgical gut
(b) Chromic surgical gut
(c) Fast absorbing plain surgical gut

19. PLAIN SURGICAL GUT
1- It loses its tensile strength in 7-10 days.
2- It is completely digested within 60 days.
3- used to ligate superficial vessels , suture
subcutaneous tissues and other
tissues that heal rapidly
3- Seldom used now due to poor strength
and high tissue reaction

20. FAST ABSORBING PLAIN SURGICAL
GUT
• It is produced by preheating
• Maintains strength for 3-5 days
• Primarily used for epidermal suturing where
sutures are required for only 5-7 days

21. CHROMIC SURGICAL GUT
• It is treated in a chromium salt solution to
improve handling and to resist absorption in
tissues
• It loses its tensile strength in 21 – 28 days
• Completely absorbed within 90 days
• Moderate tissue reaction

22. MONOCRYL
(POLIGLECAPRONE 25)
• Synthetic absorbable suture
• Monofilament
• Copolymer of glycolide and epsilon
– caprolactone
• Tensile strength –
50%-60% remains at 1 week
21%- 30% remains at 2 week
lost within 3 weeks
• Minimal acute inflamatory reaction
• Complete absorption withon 90-120 days
• Frequently used for subcuticular in skin , ligation,GIT and
muscle surgery

23. COATED VICRYL
(POLYGLACTIN 910)
• Synthetic absorble suture
• Braided multifilament coated with a mixture of equal
parts of a copolymer of glycolide , L- lactide and
calcium stearate.
• Coating provides a nonflaking lubricant for smooth
passage through tissue and precise knot placement.
• Tensile strength - =75% remains at 2wk
=50% remains at 3 wk
=25% remains at 4 wk
complete absorption within 60 -90 days
Minimal acute inflamatory reaction

24. PDSII
(POLYDIOXANONE)
• Synthetic absorbable suture
• Monofilament
• Extruded from polyester polymer
• Tensile strength - = 70% remains at 2 wk
= 50% remains at 4 wk
= 25 % remains at 6 wk
complete absorption at 180 days
Minimal tissue reaction .

25. MAXON
(POLYGLYCONATE)
• Synthetic absorbable suture
• Monofliment
• Copolymer of glycolic acid and trimethylene
carbonate
• Complete absorption within 6 months
• Tensile strength - = 70% remains at 2 wk
= 55% remains at 3 wk

26. DEXON
(POLYGYCOLIC ACID)
• Synthetic absorable suture
• Braided, multifilament
• Homopolymer of glycolic acid
• Tensile strength -
40% remains at 1wk
20% remains at 3wk
• Complete absorption within 60-90 days
• Minimal tissue reaction

27. NON ABSORBABLE SUTURES
• Strands of natural or synthetic material that
effectively resist enzymatic digestion or
absorption in living tissue .
• Examples – silk ,linen ,surgical steel , nylon etc

28. SURGICAL SILK
• It is an animal product made from the fiber
spun by silkworm larvae in making their
cocoons.
• Braided or twisted , multifilament suture
• Not a true nonabsorbable material as it loses
its much of its tensile strength after 1yr and
disappear within 2 years
• Moderate to high acute inflammatory
reactions

29. SURGICAL STEEL
• Mono or multifilament
• An alloy of iron , nickel and chromium
• Tensile strength - infinite (>1yr)
• Minimal tissue reaction
• Frequently used for sternotomy wound

30. SURGICAL NYLON
• Nylon is a polyamide polymer derived by chemical
synthesis from coal ,air and water.
• It produces minimal tissue reaction.
• It has high tensile strength
• It degrades by hydrolysis in tissue @15-20% per yr
• It is available in 3 forms –(a) monofilament
(b) uncoated
multifilament
(c) coated multifilament
Used for skin closure , abd. wall closure, plastic surgery
microsurgery , neurosurgery, ophthalmic surgery

31. ETHILON AND DERMALON
(MONOFILAMENT NYLON SUTURE)
• Long chain aliphatic polymers nylon 6 or nylon
6,6
• Good tensile strength
• Minimal tissue reactivity
• Disadvantages are its handling and knot
security

32. NUROLON
(UNCOATED MULTIFILAMENT NYLON)
• Braided
• Long – chain aliphatic polymers nylon 6 or
nylon6,6

33. SURGILON
(COATED MULTIFILAMENT NYLON)
• Braided
• Treated with silicone to enhance its smooth
passage through tissue

34. POLYESTER FIBRE SUTURE
• Polymer of terephthalic acid and polyethylene
• Monofilament or Braided multifilament
• Available in two forms – uncoated and coated
• Infinite tensile strength (>1yr)
• No significant change known to occur in vivo
• Minimal tissue reactivity

35. MERSILENE AND DACRON SUTURE
• Uncoated polyester fiber suture
• Braided , monofilament
• Exert a sawing or tearing effect when passed
through tissue

36. ETHIBOND SUTURE
• Coated polyester fiber suture
• Braided , monofilament
• Has coating of POLYBUTILATE which acts as
surgical lubricant
• Lesser sawing effect

37. PROLENE SUTURE
• Monofilament
• Isotactic crystalline stereoisomer of
polypropylene
• Most inert similar to stainless steel
• Not subject to degradation or weaking by action
of tissue enzymes
• Infinite tensile strength (>1yr)
• Frequently used for cardiovascular surgery ,
plastic, ophthalmic surgery
• Minimal tissue reactivity

38. ab

39. cont

40. Non ab

41. cont

42. Suture selection