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Suture materialsSuture materials
Mudasir BashirMudasir Bashir m.v.sc scholar m.v.sc scholar
48564856
ObjectivesObjectives
Provide basic information on Provide basic information on commonly used suture materialscommonly used suture materials
Qualities of an ideal suture: It shouldQualities of an ideal suture: It should
• Remain intact until union occurs.Remain intact until union occurs.• Cause minimum tissue reaction. Cause minimum tissue reaction. • Be non-capillary in action.Be non-capillary in action.• Be of uniform thickness.Be of uniform thickness.• Be knotable.Be knotable.• Have smooth surface. Have smooth surface. • Have sufficient tensile and functional Have sufficient tensile and functional
strength.strength.• Easily sterilizable.Easily sterilizable.• Cheap and readily availableCheap and readily available• Easy to handle.Easy to handle.
The suture is used to bringThe suture is used to bring
The edges of wound in close The edges of wound in close approximation,approximation,
to retain the medicated plug for to retain the medicated plug for dressing in deep wound or cavity, dressing in deep wound or cavity,
to close any accidental opening or to close any accidental opening or to keep the lips of a deep extensive to keep the lips of a deep extensive
open wound in contact temporarilyopen wound in contact temporarily to check recurrent haemorrhage.to check recurrent haemorrhage.
Suture MaterialSuture Material
Generally categorized by three Generally categorized by three characteristics:characteristics:• Absorbable vs. non-absorbableAbsorbable vs. non-absorbable• Natural vs. syntheticNatural vs. synthetic• Monofilament vs. multifilamentMonofilament vs. multifilament
Natural SutureNatural Suture
Biological originBiological origin Cause intense inflammatory reactionCause intense inflammatory reaction Examples:Examples:
• ““Catgut” – purified collagen fibers Catgut” – purified collagen fibers derived from intestine of healthy sheep derived from intestine of healthy sheep or cowsor cows
• Silk(non absorbable)Silk(non absorbable)
Synthetic SutureSynthetic Suture
Synthetic polymersSynthetic polymers Do not cause intense inflammatory Do not cause intense inflammatory
reactionreaction Examples:Examples:
• Vicryl(absorbable)Vicryl(absorbable)• MonocrylMonocryl• ProleneProlene• Nylon Nylon
Absorbable SutureAbsorbable Suture Degraded and eventually eliminated in Degraded and eventually eliminated in
one of two ways:one of two ways:• Via inflammatory reaction utilizing Via inflammatory reaction utilizing
tissue enzymestissue enzymes• Via hydrolysisVia hydrolysis
Examples:Examples:• ““Catgut”Catgut”• ChromicChromic• polyglactin 910 (polyglactin 910 (Vicryl)Vicryl)• MonocrylMonocryl• polyglycolic acid (Dexon) etc. polyglycolic acid (Dexon) etc.
Absorbable Suture-descriptionAbsorbable Suture-description Kangaroo tendon:Kangaroo tendon: It is obtained from It is obtained from
the tendon of tail of kangaroo and is the tendon of tail of kangaroo and is used for suturing joint capsule used for suturing joint capsule
Fascia lata:Fascia lata: It is obtained from the It is obtained from the bovine Fascia lata bovine Fascia lata
Cargile membrane:Cargile membrane: it is obtained it is obtained from bovine caecum from bovine caecum
Amniotic membrane:Amniotic membrane: It is prepared It is prepared from amniotic membrane of fetusesfrom amniotic membrane of fetuses
CatgutCatgut Absorption in tissues can be delayed Absorption in tissues can be delayed
by treating with chromic acid.by treating with chromic acid. Catgut therefore available as plain Catgut therefore available as plain
and chromic catgut.and chromic catgut.
chromic catgutchromic catgut
TypeType Degree of Degree of ChromicityChromicity
Approx No.Of Approx No.Of days taken for days taken for absorptionabsorption
Type AType A PlainPlain 10 Days10 Days
Type BType B Mild chromicMild chromic 15 Days15 Days
Type CType C Medium Medium chromicchromic
20 Days20 Days
Type DType D Extra chromicExtra chromic 40 Days40 Days
Catgut cont.Catgut cont.
Depending on preservative used Depending on preservative used catgut is available eitheras boilable catgut is available eitheras boilable or non boilable catgut.or non boilable catgut.
Boilable catgut is preserved in Boilable catgut is preserved in xylol,toulene-99.75%,phenyl xylol,toulene-99.75%,phenyl merecuric acetate.025%merecuric acetate.025%
Non boilable catgut is supplied in Non boilable catgut is supplied in tubes containing90-95%alcohol.tubes containing90-95%alcohol.
Sizes of Sizes of catgutcatgut
Diameter in Diameter in mm(average)mm(average)
UseUse
2/02/0 0.300.30 Peretoneum,bowel Peretoneum,bowel wall(small animals)and wall(small animals)and ligaturing vesselsligaturing vessels
0 or 0 or 1/01/0
0.400.40 -do--do-
11 0.480.48 Muscle Muscle fascia(SA)ligature fascia(SA)ligature larger vesselslarger vessels
22 0.500.50 -do--do-
33 0.600.60 Fascia,muscles(LA)Fascia,muscles(LA)
44 0.700.70
55 0.800.80 Rumen uterus Rumen uterus abdomenabdomen
Catgut size selectionCatgut size selection
Bowel: 2/0 - 3/0Fascia: 1 - 0Ligatures: 0 - 3/0Pedicles: 2 - 0Skin: 2/0 - 5/0Arteries: 2/0 - 8/0Micro surgery 9/0 - 10/0Corneal closure: 9/0 - 10/0
cont.cont. Collagen:Collagen: It is prepared from bovine It is prepared from bovine
flexor tendon filament flexor tendon filament Polyglactin 910Polyglactin 910 (vicryl): It is a (vicryl): It is a
synthetic absorbable suture material, synthetic absorbable suture material, prepared from glycolic lactic acid prepared from glycolic lactic acid polymer polymer
Polyglycolic acidPolyglycolic acid (Dexon): It is (Dexon): It is synthetic suture material synthetic suture material
prepared from glycolic acidprepared from glycolic acid
Non-absorbable SutureNon-absorbable Suture Not degraded, permanentNot degraded, permanent may be organic; inorganic or may be organic; inorganic or
synthetic in nature and are used synthetic in nature and are used as both the internal and external as both the internal and external suture materials. suture materials.
Non-absorbable SutureNon-absorbable Suture
Examples:Examples:• ProleneProlene• Nylon nylon Nylon nylon • Stainless steelStainless steel• Silk*Silk*
(*not a truly permanent material; (*not a truly permanent material; known to be broken down over a known to be broken down over a prolonged period of time—years)prolonged period of time—years)
Non-absorbableNon-absorbable Organic suture Organic suture materialsmaterials
CottonCotton:capillary in nature it clings :capillary in nature it clings to surgeon’s gloves and they to surgeon’s gloves and they spread infection in wound when spread infection in wound when applied to skin and luminal applied to skin and luminal surfaces surfaces
SilkSilk:: it may be plain or braided and it may be plain or braided and capillary in nature capillary in nature
Silk worm gutSilk worm gut: non-capillary and : non-capillary and useful for cutaneous suturesuseful for cutaneous sutures
cont.cont. Horse hairHorse hair: It is cheap, non-capillary, : It is cheap, non-capillary,
flexible and is easily sterilized. It causes flexible and is easily sterilized. It causes little tissue reaction.little tissue reaction.
LinenLinen: It is capillary in nature and : It is capillary in nature and
produces more tissue reaction than produces more tissue reaction than cotton and silk. cotton and silk.
Umbilical tapeUmbilical tape: used to tie the : used to tie the umbilical cord of the new born or as umbilical cord of the new born or as vulvar suture in cases of prolapse of vulvar suture in cases of prolapse of vagina of uterus. vagina of uterus.
Polyester:Polyester:is a non absorbable, is a non absorbable, sterile, surgical suture composed sterile, surgical suture composed of Poly (ethylene terephthalate).of Poly (ethylene terephthalate).
It suture elicits a minimal acute It suture elicits a minimal acute inflammatory reaction in tissues.inflammatory reaction in tissues.
polyamide:polyamide:Being monofilament, Being monofilament, Linex is remarkably smooth and Linex is remarkably smooth and gives excellent knotsecurity. gives excellent knotsecurity. Posses good tensile strength. Posses good tensile strength.
Easy removal with no Easy removal with no tissueadherence. tissueadherence.
Non-absorbable Inorganic Non-absorbable Inorganic suture materialsuture material
Metallic suture: Wire of Metallic suture: Wire of different metals like different metals like tantalum, silver,tantalum, silver,
copper, stainless steel and copper, stainless steel and vitalliumvitallium
Tantalum: It is inert to Tantalum: It is inert to
tissues like stainless steel tissues like stainless steel
Stainless steel sutureStainless steel suture
cont..cont..
SilverSilver: It becomes ionized in tissues : It becomes ionized in tissues and cause inflammation.and cause inflammation.
CopperCopper: It is more suitable to repair : It is more suitable to repair fractures due to its flexibility. fractures due to its flexibility.
Aluminium wireAluminium wire: It is more flexible : It is more flexible than stainless steel.than stainless steel.
Placing of suturesPlacing of sutures
If sutures are placed far apart-Proper If sutures are placed far apart-Proper apposition of wound edges may not apposition of wound edges may not take place.take place.
But if placed too close together-But if placed too close together-holding power of tissue diminishes.holding power of tissue diminishes.
Optimum suture distanceOptimum suture distance -Skin sutures about 5-6mm(3/8 inch)-Skin sutures about 5-6mm(3/8 inch) -Hollow visceral organs 2mm (1/8 -Hollow visceral organs 2mm (1/8
inch)to prevent leakage of contents.inch)to prevent leakage of contents.
Multifilament (braided)Multifilament (braided)
Suture ClassificationSuture Classification
MonofilamentMonofilament
Monofilament SutureMonofilament Suture
Grossly appears as single strand of suture Grossly appears as single strand of suture material; all fibers run parallelmaterial; all fibers run parallel
Minimal tissue traumaMinimal tissue trauma Resists harboring microorganismsResists harboring microorganisms Ties smoothlyTies smoothly Requires more knots than multifilament Requires more knots than multifilament
suturesuture Possesses memoryPossesses memory Examples:Examples:
• Monocryl, PDS, Prolene, NylonMonocryl, PDS, Prolene, Nylon
Multifilament SutureMultifilament Suture
Fibers are twisted or braided togetherFibers are twisted or braided together Greater resistance in tissueGreater resistance in tissue Provides good handling and ease of Provides good handling and ease of
tyingtying Fewer knots requiredFewer knots required Examples:Examples:
• Vicryl (braided)Vicryl (braided)• Chromic (twisted)Chromic (twisted)• Silk (braided)Silk (braided)
Braided v MonofilamentBraided v Monofilament
Has capillary actionIncreased infection riskLess smooth passageLess tensile strengthBetter handlingBetter knot security
No capillary actionLess infection riskSmooth tissue passageHigher tensile strengthHas memoryMore throws required
Silk Silk CatgutCatgut
NaturalNatural• Silk, linen, catgutSilk, linen, catgut
Synthetic Synthetic polymerpolymer• Polypropylene, Polypropylene,
polyester, polyester, polyamidepolyamide
Polypropylene Polyester
nylonnylon
MonofilamentMonofilament• PolypropylenePolypropylene• PolydioxanonePolydioxanone• NylonNylon
MultifilamentMultifilament• Catgut (twisted)Catgut (twisted)• PolyesterPolyester• Silk (braided)Silk (braided)
Polyester silkPolyester silk
Suture DegradationSuture Degradation
Suture MaterialSuture Material Method of Method of DegradationDegradation
Time to Time to DegradationDegradation
““Catgut”Catgut” Proteolytic Proteolytic enzymesenzymes DaysDays
Vicryl, MonocrylVicryl, Monocryl HydrolysisHydrolysis Weeks to Weeks to monthsmonths
Suture SizeSuture Size Sized according to diameter with “0” as reference Sized according to diameter with “0” as reference
sizesize Numbers alone indicate progressively larger Numbers alone indicate progressively larger
sutures (“1”, “2”, etc)sutures (“1”, “2”, etc) Numbers followed by a “0” indicate progressively Numbers followed by a “0” indicate progressively
smaller sutures (“2-0”, “4-0”, etc)smaller sutures (“2-0”, “4-0”, etc)
Smaller Smaller ------------------------------------------------------ Larger Larger
.....”3-0”...”2-0”...”1-0”.....”1”...”2”...”3”..........”3-0”...”2-0”...”1-0”.....”1”...”2”...”3”.....
The Suture PackagingThe Suture Packaging
STRAND SIZE
MATERIAL
STRAND LENGTH
PRODUCT CODE
NEEDLE CODE
WITH LIFE SIZE
PICTURE OF
NEEDLE
NEEDLE LENGTHCOLOUR
POINT TYPE
NEEDLE CIRCLE
Suture PackagingSuture Packaging
Non absorbable suturesNon absorbable sutures
EthiconEthicon
Braided silk blackBraided silk black TrulonTrulon
Monofilament Monofilament polyamidepolyamide
TruleneTrulene
Monofilament Monofilament polypropylenepolypropylene
Absorbable suturesAbsorbable sutures
Polypropylene Mesh for Hernia RepairPolypropylene Mesh for Hernia Repair
Are provided with very High Bursting Are provided with very High Bursting Strength,Elasticity and tested for Bio-Strength,Elasticity and tested for Bio-compatiability after implantation.compatiability after implantation.
They are available in popular sizes of They are available in popular sizes of 2x4, 3x6, 6x6 and 12x12 inches. 2x4, 3x6, 6x6 and 12x12 inches. Available in two types, namely PM Available in two types, namely PM and PS types.and PS types.
Polypropylene MeshPolypropylene Mesh
PM type mesh is thinner, smoother and PM type mesh is thinner, smoother and more flexible. Where as PS mesh is Strong, more flexible. Where as PS mesh is Strong,
thicker and normal flexibility.thicker and normal flexibility.
Types of hernia meshesTypes of hernia meshes
NeedlesNeedles
• Classified according to shape and type of Classified according to shape and type of pointpointCurved or straight (Keith needle)Curved or straight (Keith needle)Taper point, cutting, or reverse cuttingTaper point, cutting, or reverse cutting
Atraumatic needles- to suture delicate Atraumatic needles- to suture delicate tissues like intestine, stomach, tissues like intestine, stomach, bladder, uterus etc.bladder, uterus etc.
Double curved and loopuyt needles -Double curved and loopuyt needles -for skin closure of cattle or buffalo and for skin closure of cattle or buffalo and for deeper structures. for deeper structures.
NeedlesNeedles
CurvedCurved• Designed to be held Designed to be held
with a needle with a needle holderholder
• Used for most Used for most suturingsuturing
StraightStraight• Often hand heldOften hand held• Used to secure Used to secure
percutaneously percutaneously placed devices (e.g. placed devices (e.g. central and arterial central and arterial lines)lines)
Needle CurvatureNeedle Curvature
NeedlesNeedles
Taper-point needleTaper-point needle• Round bodyRound body• Used to suture soft Used to suture soft
tissue, excluding tissue, excluding skin (e.g. GI tract, skin (e.g. GI tract, muscle, fascia, muscle, fascia, peritoneum)peritoneum)
Needle point GeometryNeedle point GeometryTaper-Taper-PointPoint
Suited to soft tissueSuited to soft tissueDilates rather than cutsDilates rather than cuts
Reverse Reverse cuttingcutting
Very sharpVery sharpIdeal for skinIdeal for skinCuts rather than dilatesCuts rather than dilates
ConventioConventional Cuttingnal Cutting
Very sharpVery sharpCuts rather than dilatesCuts rather than dilatesCreates weakness allowing Creates weakness allowing suture tearoutsuture tearout
Taper-Taper-cuttingcutting
Ideal in tough or calcified Ideal in tough or calcified tissuestissuesMainly used in Cardiac & Mainly used in Cardiac & Vascular procedures.Vascular procedures.
Needle Point GeometryNeedle Point Geometry
BluntBlunt
Also known as “Protect Point”Also known as “Protect Point”Mainly used to prevent needle stick Mainly used to prevent needle stick injuries i.e. for abdominal wall injuries i.e. for abdominal wall closure.closure.
Premium Premium point spatulapoint spatula
Ophthalmic SurgeryOphthalmic Surgery
SpatulaSpatulaOphthalmic SurgeryOphthalmic Surgery
DermaX*DermaX*NEW: NEW: ½ The Penetration force½ The Penetration force½ The Penetration force½ The Penetration forceSuperior Cosmetic EffectSuperior Cosmetic Effect
The Right Needle ChoiceThe Right Needle Choice
The appropriate needle choice for The appropriate needle choice for any situation is……………. any situation is…………….
…………………………The needle that will cause The needle that will cause least possible trauma to the tissue least possible trauma to the tissue being suturedbeing sutured
NeedlesNeedles
Cutting needleCutting needle• Triangular bodyTriangular body• Sharp edge toward Sharp edge toward
inner circumferenceinner circumference• Used to suture Used to suture skinskin
or tough tissueor tough tissue
Using needle holder, grasp needle about Using needle holder, grasp needle about 2/32/3rdsrds of the way back from point of the way back from point..
Index finger stabilizes the Index finger stabilizes the instrument by resting on the shaft.instrument by resting on the shaft.
Surgical ScissorsSurgical Scissors
FORCEPSFORCEPS
Grasp forceps between thumb & middle finger, Grasp forceps between thumb & middle finger, while index finger is used for stabilization.while index finger is used for stabilization.
If possible, use forceps to grasp If possible, use forceps to grasp dermisdermis, rather , rather than than epidermisepidermis or or skin surfaceskin surface itself. itself.
This helps prevent marking & injuring of skin at This helps prevent marking & injuring of skin at wound edge.wound edge.
Steri-stripsSteri-strips Sterile adhesive tapesSterile adhesive tapes Available in different Available in different
widthswidths Frequently used with Frequently used with
subcuticular suturessubcuticular sutures Used following staple Used following staple
or suture removalor suture removal Can be used for Can be used for
delayed closuredelayed closure
StaplesStaples
Rapid closure of Rapid closure of woundwound
Easy to applyEasy to apply Evert tissue when Evert tissue when
placed properlyplaced properly
DermabondDermabond®®
A sterile, liquid topical skin A sterile, liquid topical skin adhesiveadhesive
Reacts with moisture on skin Reacts with moisture on skin surface to form a strong, surface to form a strong, flexible bondflexible bond
Only for easily approximated Only for easily approximated skin edges of woundsskin edges of wounds• punctures from minimally punctures from minimally
invasive surgeryinvasive surgery• simple, thoroughly cleansed, simple, thoroughly cleansed,
lacerationslacerations
AMCRYLATEAMCRYLATE®® Gel Gel Iso-amyl-2-cyanoacylateIso-amyl-2-cyanoacylate
Method of applicationMethod of application
Control hemorrhage on Control hemorrhage on cutaneous incision on skin and keep cutaneous incision on skin and keep dry using swabs.dry using swabs.
Apply few drops of Apply few drops of Iso-amyl-2-Iso-amyl-2-cyanoacylatecyanoacylate over the wound edges.over the wound edges.
Hold skin edges in proper opposition Hold skin edges in proper opposition for about 20 seconds to achive union for about 20 seconds to achive union of skin woundof skin wound
Even a small droplet of blood at Even a small droplet of blood at wound edges causes effervescence wound edges causes effervescence and non union at that point.and non union at that point.
Clean that area and dry and reapply Clean that area and dry and reapply tissue adhesivetissue adhesive
Thank youThank you