Suture

The word "suture" describes any

strand of material used to ligate
(tie) blood vessels or approximate
(sew) tissues.

History

In the10th century AD
ABUL QASIM AL ZAHRAVI in Baghdad
successfully Performed Thyroid Surgery
with the help of sutures.

Ideal Suture

Sterile
Easy to handle
Minimal tissue reaction/trauma
High tensile strength retention
Knot security
Absorbable
Useful in all tissues

Suture Classification
Absorbable / Nonabsorbable
Natural / Synthetic
Braided / Monofilament

Absorbable Sutures

Definition- sutures that can be absorbed into the

body by either enzymatic or hydrolytic processes.

Nonabsorbable

Definition - Sutures that are not absorbed

into the body.

Natural

Definition - Sutures made of material that

can be found in nature.

Synthetic

Definition - Sutures made from materials

created by man.

Monofilament

Definition- A single strand of material

Properties
- Less traumatic
- Resist Bacterial harboring

Braided(multifilament)

Definition- Multifilament sutures that consist

of several filaments or strands, twisted or
braided together.
Properties
- Greater tensile strength
- Pliability and flexibility

Example Suture Selection

Absorbable

Non Absorbable

Natural

Natural
Plain Gut
Chromic gut

Synthetic

Silk
Stainless steel

Synthetic
nylon

VICRYL*

polyester

( polyglactin 910) suture

PROLENE*
(polypropylene) suture

Example Suture Selection

Absorbable
Natural

Plain Gut

Chromic Gut

Plain Gut

Natural Absorbable
Monofilament

Submucosal or serosal layer of sheep

intestine
Packed wet to keep supple
resorbs quickly In oral cavity rarely lasting
longer than 3-5 days
absorption
60-90 days

Chromic

Natural Absorbable
Monofilament

Submucosal or serosal layer of sheep intestine

Packed wet to keep supple
Chromicizing (chromic acid treated gut) process
prolongs strength retention
chromic gut lasts longer upto 7-10days
absorption 90 days

Gut Sutures

Natural Absorbable
Monofilament

Advantages
- no foreign body left
- minimal tissue trauma
- minimizes tissue reactions
- pliable, good handling & knotting

Chromic Gut
Absorption is by enzymatic action
Absorption is unpredictable
Tissue reactions occur

Natural Absorbable
Monofilament

Example suture selection

Absorbable
Synthetic

VICRYL Rapide

VICRYL

VICRYL*
(polyglactin 910) suture

Mass absorption 56-70 days

Synthetic
Absorbable Braided

VICRYL*

Synthetic
Absorbable Braided

(polyglactin 910) suture

Advantages
SYNTHETIC

Predictable absorption less tissue reaction

ABSORBABLE

No foreign body left

COATING

Easier passage through tissue

Minimal trauma in tissue
Knots slide easily
Coating is not removed in presence of fluids

Example suture Selection

Nonabsorbable
Natural

Silk
Stainless steel

SILK

Natural
Nonabsorbable
Braided

Made from silkworm cocoons

Excellent handling & knot tying
characteristic
Standard for many years
Wicking action: because of multifilament carry bacteria along with saliva

Stainless Stell
(stainless steel 316l) suture

Natural Nonabsorbable
Monofilament

Where extra strength is required

Sternum closure
Special packaging to minimize kinks
Pull out tendon sutures
Cardiac pacing wires

Example Suture Selection

Nonabsorbable
Synthetic

PROLENE

PROLENE*
(polypropylene) suture

Polypropylene
Most inert material
Stretching and handling properties
Knot security
Used in vascular surgery
Skin & subcuticular layer

Synthetic
Nonabsorbable
Monofilament

Prolene*
(Polypropylene) suture

Synthetic
Nonabsorbable
Monofilament

Advantages

MONOFILAMENT
SYNTHETIC

Easy to remove

Minimal tissue reactions even in

the presence of infection

Provides permanent wound

support.