Suture Classification
Physical/Mechanical
Size (diameter)
Number of Filaments
Tensile strength and
elongation
Elastic modulus
Bending stiffness
Stress relaxation and creep
Capillarity
Swelling
Coefficient of friction
Handling
Pliability
Packaging
memory
Knot tie-down
Knot slippage
Tissue drag
Biocompatibility
Biodegradation
Inflammatory
reaction
Propensity toward
wound
infection,
thrombi
formation,
carcinogenicity,
and allergy
Tensile breaking
strength and mass
loss
Biocompatibility of
degradation
properties
Absorbability
Lose 50% of breaking strength within 60 days of
implanting
Monofilament, braided, or twisted
Natural or synthetic
Natural enzymatic attack
Synthetic hydrolysis
More stable mechanism
Synthetic Fiber
BSR
Poly(glycolide-co-caprolactone)
(Monocryl)*
Poly(p-diaxonone) (PDS
II)*
Monofilament
Poly(glycolide cotrimethylene
carbonate) (Maxon)
+
Polyglactin 910 (Vicryl)*
Polyglactin 910 (Vicryl
Rapide)*
Polyglycolic acid
(Dexon)+
Braided
Twisted
7
35
35
15
5
12
1
4
8
11
Nonabsorbable
Retain majority of breaking strength for
more than 60 days
Three classes
Class I silk, monofilament, and sheathed
Class II cotton and linen
Class III metallics
Braided
Polyester (Mersilene*)
Silk
Nylon (Surgilon* & Nurolon+)
Multifilament Sheathed
*Ethicon Inc., +Davis & Geck Inc., #Deknatel Inc., $S. Jackson Inc.
European
Diameter in mm
Differences in tensile
strength of materials
make comparisons
difficult
Suture Sizes/Use
Examples of Suture Sizes for Use in Pet Animals
10-0 - 8-0
7-0 - 5-0
Microvascular
Corneal
Ophthalmic
Neural
Vascular
4-0 - 3-0
2-0 - 0
Abdominal Fascia
Stomach
Hernia
1-2
Rib Retention
Cutaneous Stents
Increase or decrease abdominal fascia and retention sutures appropriately based on weight & suture pattern
Wet
Dry
Knotted
Absorption of bodily fluids
Hydrophobic
Hydrophilic
Abuse
Heat history re-autoclaving
Dia. inches
3-0
2-0
No. 3-0
lbs.
Knotted Pull
No. 2-0
psi.
lbs.
No. 3-0
psi.
lbs.
No. 2-0
psi.
lbs.
psi.
Surgical
Gut
Dexon
Vicryl
PDS II
Maxon
0.0125
0.0100
0.100
-
0.0160
0.0127
0.0130
0.0130
0.0153
6.7
6.1
-
54600
77800
-
9.8
9.6
11.5
14.8
48000
75900
80000
80000
3.8
3.9
5.0
-
30900
49700
-
5.7
6.4
7.9
10.8
28000
50300
50000
58000
Silk
Cotton
Polyprop
ylene
Nylon
Polyeste
r
0.104
0.0103
0.0097
0.0131
0.0128
0.0123
0.0131
0.0131
5.3
4.0
8.5
62400
48000
115000
8.2
5.5
7.6
9
14.5
60900
40200
63000
67000
107600
3.4
2.7
3.8
4.3
3.7
40000
32400
50100
4.8
3.5
5.5
6.5
6.8
35600
27200
46000
48000
50400
Coating Materials
Facilitate handling
Ease of passing through tissue
Ease in sliding knots down
But can result in poor knot security
Nonabsorbable coatings
Beeswax
Silicone
Paraffin wax
Poly(tetrafluoroethylene)
Absorbable
Must be absorbable like the suture
Water soluble
Water insoluble break down by hydrolysis
Ligating Clips
Essentially clips to
replace sutures when
occluding (closing) the
lumen (central canal) of
a vessel or tubular
organ
Blood vessels
Gynecological &
urological (GU)
procedures
Metallic or polymeric
Requirements
Nontoxic and
biocompatible
Absence of allergic and
immunogenic effects
Tolerated by wide range
of tissue types
High strength and low
solubility
Finite longevity
Secure
Metallic Clips
Polymeric Clips
Absorbable and nonabsorbable
Viscoelastic
Creep
Stress-relaxation
Surgical Stapling
Introduced in the late
1970s
Used widely in human
and veterinary
medicine
Gynecological
Cardiovascular
Gastrointestinal
Esophageal
Pulmonary
Staples originally
stainless but now Ti
and polymeric used
Polymeric 2 parts
U-shaped fastener
Figure 8 retainer
Surgical Staples
Staple
Staple Gun
Staple Remover
Speed
Convenience
Reduced infection rate
Lower cost
If done properly, no cosmetic difference
Before Curing
Tissue Adhesives
After Curing
Sterilizable
Easy in preparation
Viscous liquid or liquid
possible for spray
Nontoxic
Rapidly curable under
wet physiological
conditions (pH 7.3, 37C,
1 atm)
Reasonable cost
Strongly bondable to
tissues
Biostable union until
wound healing
Tough and pliable
Resorbable after wound
healing
Nontoxic
Nonobstructive to wound
healing or promoting
wound healing
Synthetic Systems:
Poly-Alkyl-2-Cyanoacrylates
Discovered in 1951
Crazy Glue
H2C=CCO2R
CN
R = alkyl group
CH3 (methyl)
H3CCH2 (ethyl)
Excellent
Poor
Set time
Medium
Short
Poor
Good
Pliability
Excellent
Poor
Toxicity
Low
Medium
Resorbability
Good
Poor
Cell infiltration
Excellent
Poor
Tissue bonding
Collagen-based adhesives