1256 C.
Suture Materials
CHAPTER OUTLINE
Classification I
Classification II
Classification III
Features of ideal suture material
 Adequate tensile strength
 Good knot holding property
 Should be least reactive
 Easy handling property
 Should have less memory
 Should be easily available and cost effective
CLASSIFICATION I
Absorbable Suture Materials
SRB's Manual of Surgery
o Plain catgut is derived from submucosa of jejunum of
sheep.
 It is yellowish white in colour.
 It is absorbed by inflammatory reaction and phagocy-
tosisabsorption time is 7 days.
 It is used for subcutaneous tissue, muscle, circumcision
in children.
o Chromic catgut is catgut with chromic acid salt.
 It is brown in colour.
 Its absorption time is 21 days.
 It is used for suturing muscle, fascia, external oblique
aponeurosis, ligating pedicles, etc.
o Vicryl (Polyglactic acid):
 It is synthetic absorbable suture material.
 It gets absorbed in 90 days.
 Absorption is by hydrolysis.
 It is violet in colour (braided).
 It is multifilament and braided.
 It is very good suture material for bowel anastomosis,
suturing muscles, closure of peritoneum.
o Dexon (Polyglycolic acid) is synthetic absorbable suture
material like vicryl. It is creamy yellow in colour (braided).
o Maxon (Polyglyconate) monofilament.
o PDS (Poly Dioxanone Suture material) is absorbable suture
material. It is creamy in colour with properties like vicryl.
It is costly but better suture material than vicryl.
o Monocryl (Polyglecaprone) monofilament.
o Biosyn (Glycomer) monofilament.
Classification IV
Classification V
Uses of absorbable suture materials
 In bowel anastomosis like gastrojejunostomy, resection and
anastomosis. Vicryl is used
 In cholecystojejunostomy (CCJ), choledocho-jejunostomy
(CDJ), pancreaticojejunostomy. Vicryl is used
 In suturing muscle, fascia, peritoneum, subcutaneous tissue,
mucosa
 In ligating pedicles. 1-zero chromic catgut or vicryl are used,
e.g. ligation of pedicles during hysterectomy
 In circumcision, usually 3-zero plain or chromic catgut are used
Absorbable suture materials should not be used for suturing
tendon, nerves, vessels (vascular anastomosis).
Nonabsorbable Suture Materials
o Silk is natural, multifilament, braided, non-absorbable
suture material derived from cocoon of silkworm larva.
It is black in colour. It is coated suture material to reduce
capillary action.
o Polypropylene (Prolene) is synthetic, monofilament suture
material. It is blue in colour. It has got high memory.
(Memory of suture material is recoiling tendency after
removal from the packet. Ideally suture material should
have low memory.) (Prolene mesh used for hernioplasty is
white in colour).
o Polyethylene (Ethylene) is synthetic monofilament nonab-
sorbable suture material. It is black in colour.
o Cotton is twisted multifilament natural nonabsorbable suture
material. It is white in colour.
o Linen is derived from bark of cotton tree.
o Steel, polyester, polyamide, nylon are other nonabsorbable
suture materials.
Uses of nonabsorbable suture materials
 In herniorrhaphy for repair
 For closure of abdomen after laparotomy
 For vascular anastomosis (6-zero), nerve suturing, tendon
suturing
 For tension suturing in the abdomen
 For suturing the skin
 CLASSIFICATION II Types of suturing 1257
Natural  Continuous suturing
o Catgut.  Interrupted simple suturing
o Silk.  Interrupted mattress suturing
o Cotton.  Subcuticular suturing
o Linen.  Horizontal tension suturing
 Vertical tension suturing
Synthetic
o Vicryl, dexon, PDS, maxon.
o Polypropylene, polyethylene, polyester, polyamide.

CLASSIFICATION III
o Braided: Polyester, polyamide, vicryl, dexon, silk.
o Twisted: Cotton, linen.

CLASSIFICATION IV
o Monofilament: Polypropylene, polyethylene, PDS, catgut,
steel.
o Multifilament: Polyester, polyamide, vicryl, dexon, silk,
cotton.

CLASSIFICATION V

Asepsis and Sterilisation

o Coated.
o Uncoated.

Numbering of Suture Material

2-Thick. For pedicle ligation.
1-
0-zero.
1-zero.
2-zero. For bowel suturing.
3-zero. Fig. 32.45: Types of suturing.
4-zero.
5-zero. For vascular anastomosis.
Types of knots
6-zero.
7-zero.  Reef knot
8-zero.  Granny knot
9-zero. For ophthalmic surgery. Requires operating  Surgeons knot
microscope.

Fig. 32.44: Photo showing different types of

suture materials (with pack). Fig. 32.46: Types of knots.

Sadness is a from of fatigue.