Suture Materials HISTORY OF SUTURE Earliest Reference EDWIN SMITH PAPYRUS 1600 BC AD 150 GALEN ON LISTER CARBOLISED catgut

catgut SUTURE IS A BEACH OF ANY MATERIAL USED FOR • Blood vessels • Trans ligating Fixing • Approximating tissues THE IDEAL SUTURE Moynihan 1912 Monofilament Absorbable • • • • Use for any Predictable absorption Procedure • E asy to handle • Minimal Tissue Reaction • High Breaking Strength • Securely Hold s Knots • Sterile Choice of suture • Familiarity • Ease of handling characteristics • Tissue • Knowledge of physica l and biological • Patient characteristics of the suture factor infection, debility, obesity CLASSIFICATION OF SUTURE Absorbable NONABSORBABLE Monofilament Braided SYNTHETIC NATURAL CLASSIFICATION OF SUTURE Plain / F.A. Good Silk Natural Chromic Gut Vicryl Rapide * Natural Ethibond VICRYL * * Synthetic Synthetic Monocryl PDS * II * ETHILON PROLENE * * Stainless Steel Absorbable Suture NON - Absorbable Suture Absorbable ADVANTAGE - - Broken down by body No Foreign body left Disadvantage - Time of Wound Support

NONABSORBABALE ADVANTAGE - Permanent Wound Support Disadvantage - Foreign body left - Sinus Suture - Suture Extrusion Monofilament ADVANTAGE - Smooth Surface - Low Friction - Less Drag - Less tissue trauma - Les s Tissue Infection - No Capillarity Monofilament Disadvantage - Handling and Knotting - Stretch ability and bendingPLIABILTY Braided ADVANTAGE - Strength - Soft and Pliable - Good handling Braided Disadvantage-Capillary Action-tissue trauma, tissue drag-Tissue Cutting Harbors bacteria In vivo performance of absorbable sutures • tensile strength retention • Absorption rate Catgut • 99% purified COLLAGEN FROM Submucosa INTESTINE OF SHEEP • Essentially monofilament • PROCESSED BY TRU Gaugi ng WHICH ENSURE UNIFORM DIAMETER WHICH ADDS STRENGTH AND TRU CHROMICISING • AVAI LABLE AS PLAIN AND Chromic catgut Catgut PLAIN • Tensile Strength • DAYS 70-10 DAYS ABSORPTION -70 • • CAUSE MORE TISSUE REACTI ON TO USES Ligat Superficial BLOOD VESSELS, Subcutaneous Tissue, LIP AND ORAL MUCOSA Chromic catgut • CHROMICISING THE AGE TO SHADE • BROWN AND RESIST digestive enzymes • Prolong ABSORPTION LESS TISSUE REACTION • Tensile Strength • ABSORPTION IN LAST 10-14 DAYS 90-110 DAYS • USED IN ALL PROC EDURES Gynecological, suturing peritoneum, MUSCLES AND FASCIA • STORED IN A FLUID THAT KEEPS IT AND SUPPL Hydrated • Sterilised BY GAMMA Irradiation with 2.5 MEGA RADS • REACTI ON TO OR Impurities mucopolysaccharides RARE Catgut ABSORPTION PLAIN WOUND SUPPORT 7-10 days 10-14 days Chromic MASS ABSORPTION 60-90 days 90-110 days Synthetic Absorbable Synthetic Absorbable

• polyglactin 910 (Vicryl) • • Gamma Irradiated POLYGLACTIN370 COATED COATED Polyglactin (Vicryl RAPIDE) • POLYGLICAPRONE 25 (Monocryl) • • CAPROFYL AND PDS PDS II Synthetic Absorbable • PREPARED FROM TWICE AS STRONG AS Carbohydrate • NATURAL Absorbable monofilament AND AS AVAILABLE • Braided • Dependable • ABSORPTION RAT E AND LEAVE BEHIND FULLY ABSORPED NO FOREIGN BODY BY ABSORPTION • hydrolysis • E XCELLENT HANDLING • Sterilised BY ETHYLENE OXIDE AND SHELF LIFE OF 5 YARS Vicryl • polyglactin AND lactide in 9:1 POLYMER SEQUENCE • Maintain 60% STRENGTH AT 2 WEEKS, 30% AT 3 WEEKS COMPLETE ABS ORPTION • AT60-90 DAYS COATED VICRYL • HAS polyglactin 370 COATING ON Polyglactin 910 • polyglactin 370 HAS 50% polyglactin (65% AND 35% glycolide lac tide) AND 50% CALCIUM STEARATE • COATING SURFACE TENSION REDUCER AND BEHAVE AS A monofilament Coated Vicryl • STRENGTH RETENTION • At 14 days - 75% Tensile Strength remains • At 21 days - 50% Tensile Strength remains Coated Vicryl • WOUND SUPPORT : 28-35 DAYS • MASS ABSORPTION: 56-70 DAYS Vicryl RAPIDE • COATED polyglactin 910 EXPOSED TO GAMMA Irradiation WHICH MAKES IT LOW MOLECULAR WEIGHT WITH A 30% LESS • Tensile Strength Tensile STRENGTH LOSS OF DAYS BETWEEN 1012 • COMPLETE ABSORPTION in 42 DAYS • USED FOR SKIN / MUCOSA, Oral / Vaginal • SKIN GRAFT, Circumcision Monocryl • 75% AND 25% glycolide Caprolactone • • Undyed Dyed VIOLET OR HIGHEST STRENGTH AMONG MOST Pliable Absor bable • WITH EXCELLENT HANDLING PROPERTIES • LOWEST • Tensile stiffness index ST RENGTH IS 60% AT 1 WEEK AND 0 DAYS AT 21% COMPLETE • ABSORPTION 90-120 DAYS USES • Subcutaneous • subcuticular CLOSURE SKIN CLOSURE PROCEDURES • Urological • Bow el anastomosis • Peritoneal CLOSURE PDS PDS AND II • polydioxanone SUTURE FORMED POYMERISING MONOMER BY PARA-dioxanone IN PRESENCE OF A CATALYST • UNIQUE FEATURE OF FLEXIBILITY • Tensile Strength 70% AT 2 WEEKS AND 25% AT 6 WEEKS • ABSORPTIO N 180-210 DAYS USES • • WOUND CLOSURE AND CAESEREAN MYOMECTOMY ORTHOPEDIC SURGERY • • • GI SURGERY C

ARDIOVASCULAR SURGERY contraindication Conjunctival suturing • • • Vaginal epithelial cuticular sutures sutures Non Absorbable • BLACK SILK (MERSILK) • Nylon (ETHILON) • POLYPROPYLENE (PROLENE) • PRONOVA Eth ibond • EXCEL • • STAINLESS STEEL Mersilene (ETHISTEEL) MERSILK • Natural Nonabsorbable - Braided • Made from Silkworm Cocoons • Twisted Virgin Wax Coated Braided Silk • Silk Black Braided Silk In vivo profiles • Tissue Reaction • BSR • Absorption - Moderate - Loose's TS - 3 Months - Fragme nts & absorbs 6-8 months MERSILK • Very good handling • Very Good Knotting • Standard for many years ETHILON • First Synthetic Monofilament Nonabsorbable • Replaced Monofilament Silk • Used mainly in Skin and Abdominal Closure ETHILON Drawbacks: • Nylon • Absorbs Water Loses Strength at a rate of 15% per annum • Suture sinuses and extrusion in some cases NYLON (ETHILON) • Smooth, easy passage through tissue • No bacterial or harbors Capillarity • St rong, Controlled Elasticity Allows Ultra Fine Gauges • Provided Long term wound support • Can be used in many applications including Opthalmics and Micro Surgery PROLENE • Synthetic • Nonabsorbable • Monofilament PROLENE • Nylon monofilament to replace • Better Control of Stretching Properties • More Pliable for handling and knotting • Smooth Surface Suture ever PROLENE • • • • • • • Extends upto 30% before breaking Indefinite Tensile Strength Excellent handling

Secured Knotting Sterilised by EO Inert and Non-Biodegradable Less thrombogenic Monofilament Knotting Suture preference • Skin-braided silk, Monocryl, nylon, Vicryl • Subcutaneous tissue rapidly-chromic / plain catgut, Vicryl • fascia, muscle-ch romic catgut, Vicryl-Monocryl • peritoneum, Vicryl, Prolene • Rectus sheath-Prol ene • Vaginal mucosa-Vicryl rapide, catgut suture • Episotomy Vicryl-rapide THANK YOU mbbsBasic www.mbbsbasic.com