Suture material

• 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.

• 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)

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

• Protecting underlying tissue from infection or other irritating factors

• Permits proper flap position

• Prevent bone exposure resulting in delayed healing and bone resorption

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

TYPE OF SUTURE MATERIAL

ACCORDING TO THEIR ORIGIN

• Organic

• Synthetic

• metallic

ACCORDING TO THEIR BEHAVIOUR IN TISSUE

• Absorbable

• Non - absorbable

• Braided

• Non braided

ACCORDING TO THEIR STRUCTURE

• Monofilament

• multifilament

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

NATURAL SYNTHETIC

Biological Synthetic polymers

Cause inflammatory reaction Less or minimal inflammatory reaction

Examples : catgut , silk Examples: nylon ,prolene

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

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

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.

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

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

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

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

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

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 weeklost within 3 weeks

• Minimal acute inflamatory reaction• Complete absorption withon 90-120 days• Frequently used for subcuticular in skin , ligation,GIT and

muscle surgery

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 daysMinimal acute inflamatory reaction

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 daysMinimal tissue reaction .

MAXON(POLYGLYCONATE)

• Synthetic absorbable suture

• Monofliment

• Copolymer of glycolic acid and trimethylenecarbonate

• Complete absorption within 6 months

• Tensile strength - = 70% remains at 2 wk

= 55% remains at 3 wk

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

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

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

SURGICAL STEEL

• Mono or multifilament

• An alloy of iron , nickel and chromium

• Tensile strength - infinite (>1yr)

• Minimal tissue reaction

• Frequently used for sternotomy wound

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 multifilamentUsed for skin closure , abd. wall closure, plastic surgery microsurgery , neurosurgery, ophthalmic surgery

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

NUROLON(UNCOATED MULTIFILAMENT NYLON)

• Braided

• Long – chain aliphatic polymers nylon 6 or nylon6,6

SURGILON(COATED MULTIFILAMENT NYLON)

• Braided

• Treated with silicone to enhance its smooth passage through tissue

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

MERSILENE AND DACRON SUTURE

• Uncoated polyester fiber suture

• Braided , monofilament

• Exert a sawing or tearing effect when passed through tissue

ETHIBOND SUTURE

• Coated polyester fiber suture

• Braided , monofilament

• Has coating of POLYBUTILATE which acts as surgical lubricant

• Lesser sawing effect

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

ab

cont

Non ab

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Suture selection