http://en.wikipedia.

org/wiki/Suture#Absorbable_and_nonabsorbable_sutures

A suture is a medical device that doctors, and especially surgeons, use to hold skin, internal organs, blood vessels and
all other tissues of the human body together, after they have been severed by injury or surgery. They must be strong (so
they do not break), non-toxic and hypoallergenic (to avoid adverse reactions in the body), and flexible (so they can be tied
and knotted easily). In addition, they must lack the so called "wick effect", which means that sutures must not allow fluids
to penetrate the body through them from outside, which could easily cause infections.
[edit] Absorbable and nonabsorbable sutures
Sutures (also known as stitches) are divided into two kinds - those which are absorbable and will break down harmlessly
in the body over time without intervention, and those which are non-absorbable and must be manually removed if they are
not left indefinitely. The type of suture used varies on the operation, with the major criteria being the demands of the
location and environment.
 Sutures to be placed internally would require re-opening if they were to be removed. Sutures which lie on the
exterior of the body can be removed within minutes, and without re-opening the wound. As a result, absorbable
sutures are often used internally; non-absorbable externally.
 Sutures to be placed in a stressful environment, for example the heart (constant pressure and movement) or the
bladder (adverse chemical presence) may require specialized or stronger materials to perform their role; usually
such sutures are either specially treated, or made of special materials, and are often non-absorbable to reduce
the risk of degradation.
[edit] Absorbable sutures
Absorbable sutures are made of materials which are broken down in tissue after a given period of time, which depending
on the material can be from ten days to eight weeks. They are used therefore in many of the internal tissues of the body.
In most cases, three weeks is sufficient for the wound to close firmly. The suture is not needed any more, and the fact that
it disappears is an advantage, as there is no foreign material left inside the body and no need for the patient to have the
sutures removed.
Absorbable sutures were originally made of the intestines of sheep, the so called catgut. The manufacturing process was
similar to that of natural musical strings for violins and guitar, and also of natural strings for tennis racquets. The inventor,
a 10th century surgeon named al-Zahrawi reportedly discovered the dissolving nature of catgut when his lute's strings
were eaten by a monkey. Today, gut sutures are made of specially prepared beef and sheep intestine, and may be
untreated (plain gut), tanned with chromium salts to increase their persistence in the body (chromic gut), or heat-treated to
give more rapid absorption (fast gut). However, the major part of the absorbable sutures used are now made of synthetic
polymer fibers, which may be braided or monofilament; these offer numerous advantages over gut sutures, notably ease
of handling, low cost, low tissue reaction, consistent performance and guaranteed non-toxicity. In Europe and Japan, gut
sutures have been banned due to concerns over bovine spongiform encephalopathy (mad-cow disease), although the
herds from which gut is harvested are certified BSE-free. Each major suture manufacturer has its own proprietary
formulations for its brands of synthetic absorbable sutures; various blends of polyglycolic acid (Biovek for example), lactic
acid or caprolactone are common.
Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.
[edit] Non-absorbable sutures

8 nonabsorbable sutures in a person's left thumb.

Nonabsorbable sutures are made of materials which are not metabolized by the body, and are used therefore either on
skin wound closure, where the sutures can be removed after a few weeks, or in some inner tissues in which absorbable
sutures are not adequate. This is the case, for example, in the heart and in blood vessels, whose rhythmic movement
requires a suture which stays longer than three weeks, to give the wound enough time to close. Other organs, like the
bladder, contain fluids which make absorbable sutures disappear in only a few days, too early for the wound to heal.
Inflammation caused by the foreign protein in some absorbable sutures can amplify scarring, so if other types of suture
are less antigenic (ie, do not provoke as much of an immune response) it would represent a way to reduce scarring.
There are several materials used for nonabsorbable sutures. The most common is a natural fiber, silk, which undergoes a
special manufacturing process to make it adequate for its use in surgery. Other nonabsorbable sutures are made of
artificial fibers, like polypropylene, polyester or nylon; these may or may not have coatings to enhance their performance
characteristics. Finally, stainless steel wires are commonly used in orthopedic surgery and for sternal closure in cardiac
surgery

Three sutures to a person's right arm, near the elbow.

[edit] Surgical needles for use with sutures
Traumatic needles are needles with holes or eyes which are supplied to the hospital separate from their suture thread.
The suture must be threaded on site, as is done when sewing at home. Atraumatic needles with sutures comprise an
eyeless needle attached to a specific length of suture thread. The suture manufacturer swages the suture thread to the
eyeless atraumatic needle at the factory. There are several advantages to having the needle pre-mounted on the suture.
The doctor or the nurse or odp does not have to spend time threading the suture on the needle. More important, the
suture end of a swaged needle is smaller than the needle body. In traumatic needles with eyes, the thread comes out of
the needle's hole on both sides. When passing through the tissues, this type of suture rips the tissue to a certain extent,
thus the name traumatic. Nearly all modern sutures feature swaged atraumatic needles.
There are several shapes of surgical needles, including:
 straight
 half curved or ski
 1/4 circle
 3/8 circle
 1/2 circle
 5/8 circle
 compound curve
Needles may also be classified by their point geometry; examples include:
 taper (needle body is round and tapers smoothly to a point)
 cutting (needle body is triangular and has a sharpened cutting edge on the inside)
 reverse cutting (cutting edge on the outside)
 trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)
 blunt points for sewing friable tissues
 side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye
surgery
Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a
sharp straight tug. These "pop-offs" are commonly used for interrupted sutures, where each suture is only passed once
and then tied.
[edit] Sizes of sutures
This article or section deals primarily with the United States and does not represent a worldwide view
of the subject.
Please improve this article or discuss the issue on the talk page.
Suture sizes are defined by the United States Pharmacopeia (U.S.P.). Sutures were originally manufactured ranging in
size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The
manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters.
As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were
manufactured, which were identified as #00 (#2-0 or #2/0) to #000000 (#6-0 or #6/0).
Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics).
Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size
differs depending on the suture material class.

A wound before and after being closed by simple interrupted sutures

Collagen Synthetic absorbable Non-absorbable
U.S.P.
metric diameter metric diameter metric diameter American wire gauge
Designation
(mm) (mm) (mm)
11-0 0.01
10-0 0.02 0.02 0.02
9-0 0.03 0.03 0.03
8-0 0.05 0.04 0.04
7-0 0.07 0.05 0.05
6-0 0.1 0.07 0.07 38-40
5-0 0.15 0.1 0.1 35-38
4-0 0.2 0.15 0.15 32-34
3-0 0.3 0.2 0.2 29-32
2-0 0.35 0.3 0.3 28
0 0.4 0.35 0.35 26-27
1 0.5 0.4 0.4 25-26
2 0.6 0.5 0.5 23-24
 3 0.7 0.6 0.6 22
4 0.8 0.6 0.6 21-22
5 0.7 0.7 20-21
6 0.8 19-20
7 18
[edit] Suture techniques
Common suture stitching techniques include:
 Simple Interrupted Stitch
 Running Stitch
 Mattress
 Horizontal mattress
 Vertical mattress
 Figure 8
 Continuous locking
 Subcuticular
[edit] Removal of sutures
While some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended
period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound. According to
about.com's article on nursing:[1]
"Different parts of the body heal at different intervals. Common time to remove stitches will vary: facial wounds 3–5 days;
scalp wound 7–10 days; limbs 10–14 days; joints 14 days; trunk of the body 7–10 days.
"Not all stitches must be removed. If a small area remains unhealed, notify the health care practitioner. Then if ordered,
remove sutures from the healed area only."
[edit] Suture materials
Polyglycolic
. Plain catgut Chromic catgut Polydioxanone (PDS)
acid (P.G.A.)
Absorbable biological
suture material.
Chromic is an
absorbable suture
made by twisting
together strands of
purified collagen taken
Absorbable biological suture from bovine intestines. It is a synthetic
material. Plain is an Due to undergoing a absorbable suture
absorbable suture made by ribbon stage material. Braided
twisting together strands of chromicisation synthetic It is a synthetic
purified collagen taken from (treatment with absorbable absorbable suture
bovine intestines. The chromic acid salts), multifilament made material. Monofilament
Description natural plain thread is the chromic offers of polyglycolic acid synthetic absorbable
precision ground in order to roughly twice the and coated with N- suture, prepared from
achieve a monofilament stitch-holding time of laurin and L-lysine, the polyester, poly (p-
character and treated with a plain catgut. The which render the dioxanone).
glycerol containing solution. natural chromic thread thread extremely
Plain is absorbed by is precision ground in smooth, soft and
enzymatic degradation. order to achieve a knot safe.
monofilament
character and treated
with a glycerol
containing solution.
Chromic is absorbed
by enzymatic
degradation.
Natural purified Polyester and poly (p-
Composition ? Polyglycolic acid
collagen dioxanone)
Tensile strength Strength retention for at ? ? ?
 least 7 days.
Structure Monofilament Monofilament Braided Monofilament
Synthetic through the
Origin Bovine serosa surface finish. Bovine serosa Synthetic
critical wound
Treatment with a
Coated with
glycerol containing
Treatment ? magnesium Uncoated
solution and chromic
stearate
acid salts
Proteolytic enzymatic
digestion complete in
Absorption by Wound support can
70 days. Absorption
hydrolysis complete remain up to 6 weeks,
Proteolytic enzymatic by enzymatic digestion
Type of between 60 and 90 however tensile
digestion complete by 90 and starts losing
absorption days. Always stength decreases to
days. tensile strength on
predictable and about 70% at 14 days
implantation from 18–
reliable and 25% at 42 days
21 days of catgut
chromic
Moderate. Plain catgut
Tissue reaction enjoys lower tissue reaction Moderate. ? ?
as compared to chromicised.
Thread color Straw Brown Violet Violet
USP 6-0 (1 metric) to USP 3 USP 6-0 (1 metric) to USP 6-0 (1 metric) USP 6-0 (1 metric) to
Size available
(7 metric). USP 3 (7 metric). to USP 2 (5 metric) USP 2 (5 metric)
Sterilization E.O. Gas. E.O. Gas E.O. gas. E.O. gas
High initial tensile
strength,
Very high knot-pull
guaranteed holding
tensile strength, good
power through the
knot security due to
Very high knot-pull tensile critical wound
special surface finish, Tensile strength
strength, good knot security healing period.
Advantages improved smoothness retention, guaranteed
due to special excellent Smooth passage
due to the dry holding power
handling features through tissue,
presentation of the
easy handling,
thread, excellent
excellent knotting
handling features
ability, secure knot
tying
PDS is particularly
For all surgical procedures useful where the
especially when tissues that combination of an
Subcutaneous,
regenerate faster are For all surgical absorbable suture and
intracutaneous
involved. General closure, procedures, especially extended wound
Indications closures, abdominal
ophthalmic, orthopedics, for tissues that support is desirable,
and thoracic
obstetrics/gynecology and regenerate faster. pediatric
surgeries
gastro-intestinal tract cardiovascular
surgery. surgery, ophthalmic
surgery
This type of suture
being absorbable is
Not recommended for This suture being
not to be used where
Not recommended for an incision that absorbable should
prolonged
incisions that require the requires sustaining of not be used where
Contraindications approximation of
sustaining of the tissues for the tissues for a extended
tissues under stress is
a prolonged period of time. prolonged period of approximation of
required and/ or in
time. tissue is required.
conjunction with
prosthetic devices
 The PDS suture knots
It is absorbed much
Special precautions should must be properly
faster when used in
be taken in patients with Special precautions placed to be secure.
the mouth and in the
cancer, anemia and should be taken in Conjunctival and
vagina, due to the
malnutrition conditions. They elderly patients and vaginal mucosal
presence of
tend to absorb the sutures at patients with history sutures remaining in
microorganism.
a higher rate. Cardiovascular of anemia and placed for extended
Cardiovascular
surgery, due to the malnutrition periods may be
surgery, due to the
continued heart contractions. conditions. As with associated with
Precautions continued heart
It is absorbed much faster any suture material, localized irritation.
contractions. Special
when used in the mouth and adequate knot Subcuticular sutures
precautions should be
in the vagina, due to the security requires should be placed as
taken in patients with
presence of microorganisms. the accepted deeply as possible in
cancer, anemia and
Avoid using where long term surgical technique order to minimize the
malnutrition
tissue approximation is of flat and square erythema and
conditions. They tend
needed. Absorption is faster ties. induration normally
to absorb this suture
in infected tissues associated with
at a higher rate.
absorption.
[edit] U.S.P. Needle Pull Specifications
U.S.P. Average Minimum Individual Minimum
Suture Size (kgf) (kgf)
11-0 0.007 0.005
10-0 0.014 0.010
9-0 0.021 0.015
8-0 0.050 0.025
7-0 0.080 0.040
6-0 0.170 0.080
5-0 0.230 0.110
4-0 0.450 0.230
3-0 0.680 0.340
2-0 1.100 0.450
0 1.500 0.450
1 1.800 0.600
2+ 1.800 0.700
[edit] Other facts
[edit] Tissue adhesives
In recent years, topical cyanoacrylate adhesives ("liquid stitches") have been used in combination with, or as an
alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing
substances/tissue, after which it cures (polymerizes) and forms a flexible film that bonds to the underlying surface. The
tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact.
Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage.
[edit] Antimicrobial sutures
Another recent development in wound closure involves the use of sutures coated with antimicrobial substances to reduce
the chances of wound infection. While long-term studies are not yet available, preliminary results indicate that these
sutures are effective at keeping bacteria out of wounds.