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:

o Properties of suture material
o Absorption rate
o Handling characteristics and knotting properties
o Size of suture
o Type of needle

Natural suture materials

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

Synthetic suture materials

• Absorbable
o Polyglycolic Acid (Dexon)
o Polyglactin (Vicryl)
o Polydioxone (PDS)
o Polyglyconate (Maxon)
• Non-Absorbable
o Polyamide (Nylon)
o Polyester (Dacron)
o 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
o 65% @ 14 days
o 40% @ 21 days
o 10% @ 35 days
• Absorption complete by 70 days

Polydioxone

• Tensile strength
o 70% @ 14 days
o 50% @ 28 days
o 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