of many suture materialshas been evaluated qualita-tively.
All sutures losestrength when knotted;many lose at least a third of their initial tensile strength
(Table I). Relative knot se-curity expresses knot-hold-ing capacity as a percentageof initial tensile strength(Table I). The effectivestrength of the suture mate-rial depends on both theinitial tensile strength andthe relative knot security (see Effective Strength of Suture Materials).
The handling characteristics of suture materials arean important consideration. Stiffer (i.e., less pliable) su-ture materials are more difficult to handle.
When us-ing a stiff suture material, the surgeon must take partic-ular care to ensure that the knots are secure.In general, monofilament sutures are stiffer than mul-tifilament sutures of the same composition, Also, larger-diameter sutures are stiffer than smaller-diameter su-tures.
Silk is so easy to han-dle that suture materials with excellent pliability aredescribed as “handling likesilk.” Poliglecaprone 25, arecently marketed absor-bable suture material, hasthe least stiffness (greatestpliability) of the absorbablesutures
(Table I). Althoughhandling characteristicsmay be the decisive factorin the choice of suture ma-terial for some surgical pro-cedures, a suture materialshould never be chosen sole-ly on the basis of its handlingcharacteristics.
Suture materials influence patient morbidity primari-ly through their interaction with tissue. Many factorsaffect this interaction, including the amount (diameterand length) of suture material in the wound as well asthe placement technique. The impact of sutures on the wound is an important consideration in the selection of a suture material. Although much is known about theinfluence of sutures as foreign material in wounds, little is known about their effecton the wound microenvironment.
Tis-sue–suture interactions are complex, involv-ing humoral and cellular factors.
Sutures alter the healing process in con-taminated or infected wounds. The pres-ence of any suture in tissue increases the tis-sue’s susceptibility to infection. Thus, theveterinarian should avoid placing suture ina contaminated wound unless it is essentialfor positioning tissue.
Both the physical construction (monofil-ament versus multifilament) and the chemi-cal composition of the suture material affect whether a contaminated wound will be-come infected.
Monofilament sutures withstand contamination better than multi-filament sutures. The number of sutures inthe wound also influences whether a con-taminated wound will become infected. Su-ture size and length should be minimized inany wound but particularly in a contami-nated wound.Because of their monofilament construc-tion, polydioxanone, polyglyconate, and
February 1998Small Animal
RELATIVE KNOT SECURITY
TABLE IIGuide for Selecting SutureSize for Small Animal Surgery
Tissue or UseRecommended Size
Skin4-0 to 2-0Subcutaneous tissue4-0 to 3-0Muscle3-0 to 2-0Fascia3-0 to 0Viscera5-0 to 3-0Ligation of small vessels4-0 to 3-0Ligation of large vessels2-0 to 1Tension sutures2-0 to 1
Data from Grier RL: Surgical sutures—Part II: Indicationsfor different suture materials and comparable costs.
Iowa State Univ Vet
TABLE IIINumber of Throws Needed to Create a Secure Knot
Continuous Pattern Interrupted Suture MaterialPattern
Poliglecaprone 25———Polydioxanone457Polyglactin 910336Polyglycolic acid335Polyglyconate———Surgical gut345
Nylon456Polyester———Polymerized caprolactum———Polypropylene335Silk———Stainless steel—N/A
For many suture materials, the number of throws needed to create a secureknot has not been established.
Not applicable: Stainless steel should not be used in a continuous suturepattern.