Suture Materials

HISTORY OF SUTURE
Earliest Reference
EDWIN SMITH PAPYRUS 1600 BC AD 150 GALEN ON LISTER CARBOLISED catgut catgut
SUTURE IS A BEACH OF ANY MATERIAL USED FOR
• Blood vessels • Trans ligating Fixing • Approximating tissues
THE IDEAL SUTURE Moynihan 1912
Monofilament Absorbable • • • • Use for any Predictable absorption Procedure • E
asy to handle • Minimal Tissue Reaction • High Breaking Strength • Securely Hold
s Knots • Sterile
Choice of suture
• Familiarity • Ease of handling characteristics • Tissue • Knowledge of physica
l and biological
• Patient characteristics of the suture factor infection, debility, obesity
CLASSIFICATION OF SUTURE
Absorbable NONABSORBABLE
Monofilament
Braided
SYNTHETIC
NATURAL
CLASSIFICATION OF SUTURE
Plain / F.A. Good Silk
Natural
Chromic Gut Vicryl Rapide *
Natural
Ethibond VICRYL * *
Synthetic
Synthetic
Monocryl PDS * II *
ETHILON PROLENE * * Stainless Steel
Absorbable Suture
NON - Absorbable Suture
Absorbable
ADVANTAGE
- - Broken down by body No Foreign body left
Disadvantage
- Time of Wound Support
NONABSORBABALE
ADVANTAGE
- Permanent Wound Support
Disadvantage
- Foreign body left - Sinus Suture - Suture Extrusion
Monofilament
ADVANTAGE - Smooth Surface - Low Friction - Less Drag - Less tissue trauma - Les
s Tissue Infection - No Capillarity
Monofilament
Disadvantage - Handling and Knotting - Stretch ability and bendingPLIABILTY
Braided
ADVANTAGE - Strength - Soft and Pliable - Good handling
Braided
Disadvantage-Capillary Action-tissue trauma, tissue drag-Tissue Cutting Harbors
bacteria
In vivo performance of absorbable sutures
• tensile strength retention • Absorption rate
Catgut
• 99% purified COLLAGEN FROM
Submucosa INTESTINE OF SHEEP • Essentially monofilament • PROCESSED BY TRU Gaugi
ng WHICH ENSURE UNIFORM DIAMETER WHICH ADDS STRENGTH AND TRU CHROMICISING • AVAI
LABLE AS PLAIN AND Chromic catgut
Catgut PLAIN
• Tensile Strength • DAYS 70-10 DAYS ABSORPTION -70 • • CAUSE MORE TISSUE REACTI
ON TO USES Ligat Superficial
BLOOD VESSELS, Subcutaneous Tissue, LIP AND ORAL MUCOSA
Chromic catgut
• CHROMICISING THE AGE TO SHADE
• BROWN AND RESIST digestive enzymes • Prolong ABSORPTION LESS TISSUE REACTION •
Tensile Strength • ABSORPTION IN LAST 10-14 DAYS 90-110 DAYS • USED IN ALL PROC
EDURES Gynecological, suturing peritoneum, MUSCLES AND FASCIA
• STORED IN A FLUID THAT KEEPS IT
AND SUPPL Hydrated • Sterilised BY GAMMA Irradiation with 2.5 MEGA RADS • REACTI
ON TO OR Impurities mucopolysaccharides RARE
Catgut ABSORPTION
PLAIN WOUND SUPPORT 7-10 days 10-14 days Chromic
MASS ABSORPTION 60-90 days
90-110 days
Synthetic Absorbable
Synthetic Absorbable
• polyglactin 910 (Vicryl) • • Gamma Irradiated POLYGLACTIN370 COATED COATED
Polyglactin (Vicryl RAPIDE) • POLYGLICAPRONE 25 (Monocryl) • • CAPROFYL AND PDS
PDS II
Synthetic Absorbable
• PREPARED FROM TWICE AS STRONG AS Carbohydrate • NATURAL
Absorbable monofilament AND AS AVAILABLE • Braided • Dependable • ABSORPTION RAT
E AND LEAVE BEHIND FULLY ABSORPED NO FOREIGN BODY BY ABSORPTION • hydrolysis • E
XCELLENT HANDLING • Sterilised BY ETHYLENE OXIDE AND SHELF LIFE OF 5 YARS
Vicryl
• polyglactin AND lactide in 9:1
POLYMER SEQUENCE • Maintain 60% STRENGTH AT 2 WEEKS, 30% AT 3 WEEKS COMPLETE ABS
ORPTION • AT60-90 DAYS
COATED VICRYL
• HAS polyglactin 370 COATING ON
Polyglactin 910 • polyglactin 370 HAS 50% polyglactin (65% AND 35% glycolide lac
tide) AND 50% CALCIUM STEARATE • COATING SURFACE TENSION REDUCER AND BEHAVE AS A
monofilament
Coated Vicryl
• STRENGTH RETENTION • At 14 days - 75% Tensile Strength
remains
• At 21 days - 50% Tensile Strength
remains
Coated Vicryl
• WOUND SUPPORT
: 28-35 DAYS
• MASS ABSORPTION: 56-70 DAYS
Vicryl RAPIDE
• COATED polyglactin 910 EXPOSED TO
GAMMA Irradiation WHICH MAKES IT LOW MOLECULAR WEIGHT WITH A 30% LESS • Tensile
Strength Tensile STRENGTH LOSS OF DAYS BETWEEN 1012 • COMPLETE ABSORPTION in 42
DAYS • USED FOR SKIN / MUCOSA, Oral / Vaginal • SKIN GRAFT, Circumcision
Monocryl
• 75% AND 25% glycolide
Caprolactone • • Undyed Dyed VIOLET OR HIGHEST STRENGTH AMONG MOST Pliable Absor
bable • WITH EXCELLENT HANDLING PROPERTIES • LOWEST • Tensile stiffness index ST
RENGTH IS 60% AT 1 WEEK AND 0 DAYS AT 21% COMPLETE • ABSORPTION 90-120 DAYS
USES
• Subcutaneous • subcuticular CLOSURE SKIN CLOSURE PROCEDURES • Urological • Bow
el anastomosis • Peritoneal CLOSURE
PDS PDS AND II
• polydioxanone SUTURE FORMED
POYMERISING MONOMER BY PARA-dioxanone IN PRESENCE OF A CATALYST • UNIQUE FEATURE
OF FLEXIBILITY • Tensile Strength 70% AT 2 WEEKS AND 25% AT 6 WEEKS • ABSORPTIO
N 180-210 DAYS
USES
• • WOUND CLOSURE AND CAESEREAN MYOMECTOMY ORTHOPEDIC SURGERY • • • GI SURGERY C
ARDIOVASCULAR SURGERY
contraindication
Conjunctival suturing • • • Vaginal epithelial cuticular sutures sutures
Non Absorbable
• BLACK SILK (MERSILK) • Nylon (ETHILON) • POLYPROPYLENE (PROLENE) • PRONOVA Eth
ibond • EXCEL • • STAINLESS STEEL Mersilene (ETHISTEEL)
MERSILK
• Natural Nonabsorbable - Braided • Made from Silkworm Cocoons • Twisted Virgin
Wax Coated Braided Silk • Silk
Black Braided Silk
In vivo profiles
• Tissue Reaction • BSR • Absorption - Moderate - Loose's TS - 3 Months - Fragme
nts & absorbs 6-8 months
MERSILK
• Very good handling • Very Good Knotting • Standard for many years
ETHILON
• First Synthetic Monofilament
Nonabsorbable
• Replaced Monofilament Silk • Used mainly in Skin and Abdominal Closure
ETHILON
Drawbacks:
• Nylon • Absorbs Water Loses Strength at a rate of 15% per
annum
• Suture sinuses and extrusion in some
cases
NYLON (ETHILON)
• Smooth, easy passage through tissue • No bacterial or harbors Capillarity • St
rong, Controlled Elasticity Allows Ultra
Fine Gauges
• Provided Long term wound support • Can be used in many applications including
Opthalmics and Micro Surgery
PROLENE
• Synthetic • Nonabsorbable • Monofilament
PROLENE
• Nylon monofilament to replace • Better Control of Stretching
Properties
• More Pliable for handling and
knotting
• Smooth Surface Suture ever
PROLENE
• • • • • • •
Extends upto 30% before breaking Indefinite Tensile Strength Excellent handling
Secured Knotting Sterilised by EO Inert and Non-Biodegradable Less thrombogenic
Monofilament Knotting
Suture preference
• Skin-braided silk, Monocryl, nylon, Vicryl
• Subcutaneous tissue rapidly-chromic / plain catgut, Vicryl • fascia, muscle-ch
romic catgut, Vicryl-Monocryl • peritoneum, Vicryl, Prolene • Rectus sheath-Prol
ene • Vaginal mucosa-Vicryl rapide, catgut suture • Episotomy Vicryl-rapide
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