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Suture Material

Author: RxPG, Posted on Sunday, January 26 @ 00:00:00 IST by RxPG  

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Surgery

Suture materials

The purpose of a suture

  • to hold a wound together in good apposition until such time as the natural healing process is sufficiently well established to make the support from the suture material unnecessary and redundant.


Choice of a suture

  • Choice of suture depends on:
    • Properties of suture material
    • Absorption rate
    • Handling characteristics and knotting properties
    • Size of suture
    • Type of needle

Natural suture materials

  • Absorbable
    • Catgut - Plain or chromic
  • Non-Absorbable
    • Silk
    • Linen
    • Stainless Steel Wire

Synthetic suture materials

  • Absorbable
    • Polyglycolic Acid (Dexon)
    • Polyglactin (Vicryl)
    • Polydioxone (PDS)
    • Polyglyconate (Maxon)
  • Non-Absorbable
    • Polyamide (Nylon)
    • Polyester (Dacron)
    • Polypropylene (Prolene)

Absorbable suture are broken down by either:

  • Proteolysis (e.g. Catgut)
  • Hydrolysis (e.g. Vicryl, Dexon)

Catgut

  • Made from the submucosa of sheep gastrointestinal tract
  • Broken down within about a week
  • Chromic acid delays hydrolysis
  • Even so it is destroyed before many wounds have healed

Silk

  • Strong and handles well but induces strong tissue reaction
  • Capillarity encourages infection causing suture sinuses and abscesses

Vicryl

  • Tensile strength
    • 65% @ 14 days
    • 40% @ 21 days
    • 10% @ 35 days
  • Absorption complete by 70 days

Polydioxone

  • Tensile strength
    • 70% @ 14 days
    • 50% @ 28 days
    • 14% @ 56 days
  • Absorption complete by 180 days

Common errors of suture use

  • Too many throws. Increases foreign body size. Causes stitch abscesses
  • Intra-cuticular rather than subcuticular sutures causing hypertrophic scars
  • Holding monofilament sutures with instruments reduces tensile strength by over 50%
  • Holding butt of needle causes needle and suture breakage



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