suture materials

 

Agent Classification Durability Uses Special points

Silk:

·         Braided

·         Biological

 

·         Theoretically

·         permanent

·         although strength

·         not preserved

 

·         Anchoring devices, skin

·         closure

 

·         Knots easily, poor

·         cosmesis

 

Catgut:

·         Braided

·         Biological

 

·         5-7 days Short term wound

·         approximation

 

·         Poor cosmesis

·         Degrades rapidly

·         Not available in UK

 

Chromic catgut:

·         Braided

·         Biological

 

·         Up to 12 weeks Apposition of deeply sited

 

·         tissues

 

·         Unpredictable

·         degradation pattern

·         Not in use in UK

 

Polydioxanone

(PDS)

 

·         Synthetic

·         Monofilament

 

·         Up to 3 months

·         (longer with thicker

·         sutures)

 

·         Widespread surgical

·         applications including visceral

·         anastomoses, dermal closure,

·         mass closure of abdominal

·         wall*

 

·         Used in most surgical

·         specialties (avoid dyed

·         form in dermal closure)

 

Polyglycolic acid

(Vicryl, Dexon)

 

·         Braided

·         Synthetic

 

·         Up to 6 weeks Most tissues can be apposed

·         using polyglycolic acid

 

·         It has good handling

·         properties, the dyed form

·         of this suture should not

·         be used for skin closure

 

Polypropylene

(Prolene)

 

·         Synthetic

·         Monofilament

 

·         Permanent Widely used, agent of choice

·         for vascular anastomoses

 

·         Poor handling properties

 

·         Polyester

(Ethibond)

 

·         Synthetic

·         Braided

 

·         Permanent Its combination of

·         permanency and braiding

·         makes it useful for

·         laparoscopic surgery

 

·         It is more expensive and

·         has considerable tissue

·         drag

 

·         *PDS or polydioxanone is the ideal suture material. Non absorbable sutures have higher incidence of incisional herniae.

·         NB: Stainless steel clips for skin following thyroidectomy.

·         NB: For closure of sternum following CABG, a stainless steel wire is typically used.

·         Absorbable vs Non absorbable

•         Time taken to degrade absorbable materials varies

•         Usually by macrophages hydrolysing material

•         Consider absorbable sutures in situations where long term tissue apposition is not required. In cardiac and

·         vascular surgery non-absorbable sutures are usually used.

·         Suture size

•         The higher the index number the smaller the suture i.e.: 6/0 Prolene is finer than 2/0 Prolene.

•         Finer sutures have less tensile strength. For example, 6/0 Prolene would not be a suture suitable for abdominal

·         mass closure but would be ideal for small Prolene distal arterial anastomoses.

·         Braided vs monofilament

·         Generally speaking braided sutures have better handling characteristics than non-braided. However, they are associated

·         with higher bacterial counts. Braided materials are unsuitable for use in vascular surgery as they are potentially

·         thrombogenic.

 

Suture Sizes

USP Suture size and corresponding suture diameter

USP Size Diameter in mm

·         11-0 0.01

·         10-0 0.02

·         6-0 0.07

·         3-0 0.2

·         0 0.35

·         1 0.4