SUTURE MATERIAL
MANGKUBUMI PUTRA WIJAYA
Introduction
The basic purpose of a suture is to hold severed tissues in close approximation
until the healing process provides the wound with sufficient strength without the
need for mechanical support
Inappropriate use of a material type can lead to wound breakdown or tissue injury.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
selection of suture material
The tissues to be repaired
The tensile strength of the suture material
Knot-holding characteristics of the suture material and the reaction of surrounding
tissues to the suture materials.
The condition of the wound
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Principles of suture selection
Rate of healing of tissues:
When a wound has reached maximal strength, sutures are no longer needed.
Tissues that ordinarily heal slowly such as skin, fascia and tendons should usually
closed with non – absorbable sutures.
Tissues that heal rapidly such as peritoneum, liver, small intestine, muscles, stomach
,colon and bladder may be closed with absorbable sutures.
Suture should be stronger than the sutured tissues, and it is unwise to implant more
material than necessary.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Tissue contamination:
Avoid multifilament sutures as bacteria can linger with them and may convert a
contaminated wound into an infected one.
Use monofilament absorbable or non- absorbable sutures in potentially contaminated
tissues. Monofilament polypropylene is ideal
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Cosmetic results :
Where cosmetic results are important, close and prolonged apposition of wounds and
avoidance of irritants will produce the best results. Therefore use a smallest, inert
monofilament suture materials such as poly amide and polypropylene.
Avoid skin sutures and close subcuticularly whenever possible
Under certain circumstances, to secure close apposition of skin edges , skin closure
tape may be used
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Biologic response of body to suture
material
Two weeks after suturing, 3-5% of original strength will be achieved by a surgical
wound.
By the end of third week, 20% of the ultimate wound strength is achieved, and by
one month only 50% of wound strength is attained.
All sutures are foreign bodies and produce an inflammatory response in the host
dermis.
Peak inflammatory response is seen between second and seventh day with
abundance of polymorphonuclear leukocytes, lymphocytes, and large monocytes
in dermis.
Between the third and eighth day, the epithelial cells deeply invade the suture
tracts.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
CLASSIFICATION OF SUTURE
MATERIAL
According to source:
According to
Natural structure:
According to fate:
Synthetic
Monofilament
Absorbable (undergo degradation and lose tensile strenght <
Multifilament
60 days)
Metallic
Non absorbable (maintain T.S > 60 days)
Jennifer Hasenyager. Needles, Sutures, Instruments. 2013
ABSORBABLE VS NON
ABSORBABLE
Absorbable Non Absorbable
Degraded by enzimes, hydrolysis or Encapsulated or walled off by fibrosis
phagocytosis Used to suture at sites where tensile
Used to hold the edges in strengh need to be maintained
approximation temporarily until the
wound is heal
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Natural
Absorbable Non Absorbable
Catgut Silk
Silk worm gut
Collagen
Linen
Fascia lata
Cotton
kangaroo tendon
Horse hair
Beef tendon
Cargile membrane
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Synthetic
Absorbable Non Absorbable
Polyglycolic Acid Nylon/ polyamide
Polyglactic Acid PolyPropylene
Polyglactin 910(Vicryl) Polyesters
Polydioxanone(PDS) Polyethelene
Polyglecaprone 25 Polybutester
Polyvinylidene fluoride /
PVDF Sutures
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Metallic
Tantalum
Gold
Silver
Aluminium
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
MonoFILAMENT
Advantages
Smooth surface
Less tissue trauma
No bacterial harbors Absorbable : Non-Absorbable :
No capillarity Surgical Gut- Polypropylene
Plain/Chromic
Disadvantages Polyester
Handling and knotting Polydiaxanone Nylon/polyamide
Stretch Polyglactin 910 Polyvinylidene fluoride
Any nick or crimp in the / PVDF Sutures
material leads to breakage.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
MultiFILAMENT
Advantages
Strength
Soft and pliable
Good handling Absorbable Non-Absorbable
Good knotting Polyglactin 910 Silk
Polyglycolic Acid Cotton
Disadvantages
Linen
Bacterial harbors
Capillary action
Tissue trauma
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
MONOFILAMENT VS
MULTIFILAMENT
Mono Multi
Difficult Handling Easy Handling
Smooth & Strong Low strength
No wicking Wicking is a problem
Thinner Thicker
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
AD Surgical. Suture Brand Conference Chart. 2014
AD Surgical. Suture Brand Conference Chart. 2014
THANK YOU
ABSORBABLE
Gut / cat gut
Oldest known absorbable suture.
Galen referred to gut suture as early as 175 A.D.
Derived from sheep intestinal sub mucosa or bovine intestinal serosa.
TS 3-4 days
Absorption : 40-60 days
When placed intra orally sutures are digested in 3- 5days.
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Chromic CATGUT
Coated with thin layer of chromium salt solution to minimize tissue reaction, increase
TS, slow the absorption rate, better knot security, and ease of handling.
TS 10-14 days
Absorbed in 90 days
Uses: Opthalmic surgery (6-0) , Oral surgery, Suture subcutaneous tissues
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Polyglycolic acid (Dexon)
This is an absorbable braided synthetic homopolymer of glycolic acid.
It is supplied as an uncoated or coated form.
Coated polyglycolic acid suture is undyed or dyed green, violet or bicolored.
Since polyglycolic acid is not a naturally occurring organic substance, it elicits
less inflammatory response than surgical gut.
TS 10-14 days, It is absorbed by hydrolysis, 90-120 days
Polyglycolic acid possesses good tensile strength and excellent knot security.
After two weeks of implantation, 65% of the initial tensile strength remains with
polyglycolic acid suture, in contrast to 0% of surgical gut suture.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
POLIGLECAPRONE 25 (Monocryl)
Absorbable, synthetic, monofilament
Poliglecaprone 25; copolymer of glycolide and caprolactone
Hydrolysis 90-120 days
Tissue reaction – minimal
Good knot strength
Used for soft tissue closure
Most pliable material ever made
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Polyglactin 910 (vicryl)
It is a synthetic heteropolymer consisting of 90% of glycolide and 10% of lactide.
These sutures are braided, multifilament, coated, absorbable synthetic sutures.
This suture is degraded by hydrolysis.
This suture can be supplied in an antibiotic form by impregnating with triclosan.
The residual tensile strength of a polyglactin 910 suture is consistently greater than
that of polyglycolic acid suture. TS - 14 – 21 days.
Polyglactin 910 sutures are absorbed more rapidly than polyglycolic acid suture.
In one study comparing the absorption of polyglactin 910 and polyglycolic acid,
the absorption of former began approximately at 40 days, and was nearly complete
by day 70.
At 90 days, no polymer remained in the tissu
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
VICRYL - RAPIDE
It is braided synthetic absorbable suture material. Colour: White.
It has a similar initial high tensile strength as that of the normal vicryl suture.
It gives wound support upto 12 days. It shows 50% of the original tensile strength
after 5 days and all of its tensile strength is lost after 14 days.
Its absorption is associated with minimal tissue reaction facilitating improved
cosmetics and reduction of postoperative pain.
The absorption is essentially complete within 35-42 days.
Uses: Low tensile strength and Rapid absorption rate --Ideal for intra-oral use
(dental surgeries).
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
VICRYL PLUS Antibacterial
Handles and performs same as normal vicryl.
In vitro studies shown that triclosan on VICRYL plus
creates a zone of inhibition around the suture.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Polyglyconate (MAXON)
It came in to market in 1985.
It is synthetic monofilament absorbable suture, composed of glycolic acid and
trimethylene carbonate.
Polyglyconate has some advantages over other sutures, such as improved
handling properties, lacks memory, passes easily through tissues and demonstrates
superior strength.
It retains 75% of original strength at two weeks of postimplantation.
TS – 14-21 days (>Dexon)
Absorption is essentially complete by 180 days.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
POLYDIOXANONE (PDS II)
Polyester derivative poly P dioxanone.
Synthetic,absorbable,monofilament.
TS -14-42 days
Absorption – Hydrolysis in 6 months.
Passes through tissues easily.
Minimal tissue reaction
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
SILK
Surgical silk is derived from silkworm species Bombyx mori of the family
Bombycidae, the larva of which spins silk to weave its cocoon.
It is a braided, black dyed, coated suture.
Coating with wax or silicone helps to reduce tissue friction and capillarity.
A special quality of silk is its ease of handling.
Unfortunately, its tensile strength is very low and it exhibits high capillarity,
which increases the risk of infection.
It loses approximately 50% of its strength in one year. Due to its property of
reactivity, it is rarely used for cutaneous closures; however, it is commonly used
on mucosal and intertriginous areas as it is soft and pliable.
NYLON
Nylon suture materials are available in mono (dermalon, ethilon) or multifilament
forms (surgilon, nurilon)
It is composed of long-chain aliphatic polymers of nylon.
Due to its property of elasticity, it is useful for surface (epidermal, superficial)
closure.
Monofilament nylon suture has a great deal of memory (Memory is the ability of
a suture material to return to previous shape after deformation.) and its proclivity
for knot slippage is known.
Multifilament braided nylon sutures exhibit decreased memory and they are
associated with higher infection rate.
In vivo, nylon loses 15−20% of tensile strength every year by hydrolyzation.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Polypropylene (Prolene)
Polypropylene (Prolene)was devloped in 1970 as a first synthetic nonabsorbable
suture. It is a monofilament suture.
Prolene is made of isotactic crystalline stereoisomer of polypropylene with few
unsaturated bonds.
Polypropylene has a tensile strength more than nylon.
It can easily pass through tissues and induces minimal host response.
It does not adhere to the tissues and can be used as an intradermal suture.
It is availableasdyedorundyedform.Ithasgoodplasticity and it expands with tissue
swelling to accommodate the wound.
High memory, poor knot security and lack of elasticity are the few disadvantages
with Prolene.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
Polyester
Polyester sutures are nonabsorbable synthetic- braided multifilament sutures
composed of polyethylene terephthalate.
They are used for prosthetic implantations, face lifts and cardiovascular surgeries
due to its unique properties, such as minimal tissue reactivity, high tensile
strength, good handling and everlasting.
It can be coated or uncoated.
Jörg Meyle. Suture Materials and Suture Techniques. Perio 2006;
Mohan H. Kudur et al. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009
