SUTURES-

SURGICAL
CATGUT AND
LIGATURE
Pharmacognosy
D. Pharm 1st Year
 INTRODUCTION
“Ligature: Material A surgical suture, also known as
used to tie something in a stitch or stitches, is a medical
surgery. Ligatures are device used to hold body tissues
used to tie off blood together and approximate wound
vessels, and they may edges after an injury or surgery.
be made of silk, gut, Application generally involves
wire, or other using a needle with an attached
materials.” length of thread.
CONT…
 There are numerous types of sutures, which differ by needle shape and
size as well as thread material and characteristics.
 Selection of surgical suture should be determined by the characteristics
and location of the wound or the specific body tissues being
approximated.
 In selecting the needle, thread, and suturing technique to use for a
specific patient, a medical care provider must consider the tensile
strength of the specific suture thread needed to efficiently hold the
tissues together depending on the mechanical and shear forces acting on
the wound as well as the thickness of the tissue being approximated
TYPES OF SUTURES
 The different types of sutures can be classified in many ways.
I. First, suture material can be classified as either absorbable or
nonabsorbable.
a. Absorbable sutures don’t require your doctor to remove them. This is because
enzymes found in the tissues of your body naturally digest them.
b. Nonabsorbable sutures will need to be removed by your doctor at a later
date or, in some cases, left in permanently.
II. Second, the suture material can be classified according to the actual
structure of the material.
a. Monofilament sutures consist of a single thread. This allows the suture to more
easily pass through tissues.
b. Braided sutures consist of several small threads braided together. This can
lead to better security, but at the cost of increased potential for infection.
III. Third, sutures can be classified as either being made from natural or
synthetic material.
 TYPES OF ABSORBABLE
SUTURES
 Gut.
 This natural monofilament suture is used for repairing internal soft tissue
wounds or lacerations.
 The gut shouldn’t be used for cardiovascular or neurological procedures.
 The body has the strongest reaction to this suture and will often scar over.
 It’s not commonly used outside of gynecological surgery.
 Polydioxanone (PDS).
 This synthetic monofilament suture can be used for many types of soft tissue
wound repair (such as abdominal closures) as well as for pediatric cardiac
procedures.
 Poliglecaprone (MONOCRYL).
 This synthetic monofilament suture is used in soft tissue repair.
 This material shouldn’t be used for cardiovascular or neurological procedures.
 This suture is most commonly used to close skin in an invisible manner.

 Polyglactin (Vicryl).
 This synthetic braided suture is good for repairing hand or facial lacerations.
 It shouldn’t be used for cardiovascular or neurological procedures.
TYPES OF NONABSORBABLE
SUTURES
 These types of sutures can all be used generally for soft tissue
repair, including for both cardiovascular and neurological
procedures.
 Nylon. A natural monofilament suture.
 Polypropylene (Prolene). A synthetic monofilament suture.
 Silk. A braided natural suture.
 Polyester (Ethibond). A braided synthetic suture.
 IDEAL PROPERTIES
 Must be sterile
 Must have sufficient tensile strength
 Must be non-irritating
 Gauge should be as fine as possible
 Absorption time for the absorbable suture and ligature should be known
 Good handling characteristics.
 Non-reactivity with tissue.
 Knot security.
 Favourable absorption profile.
 Resistant to infection.
 SURGICAL CATGUT
 Catgut suture is a type of surgical suture that is naturally degraded by the
body's own proteolytic enzymes.
 Absorption is complete by 90 days, and full tensile strength remains for at least
7 days. This eventual disintegration makes it good for use in rapidly healing
tissues and in internal structures that cannot be re-accessed for suture removal.
 Catgut suture has high knot-pull tensile strength and good knot security due to
special excellent handling features.
 It is used for all surgical procedures, including general closure, ophthalmic,
orthopedics, gynecology, and gastrointestinal surgery.
 It is absorbed faster in patients with cancer, anemia, and malnutrition. It also absorbs faster
when used in the mouth and the vagina due to the presence of microorganisms.
 Catgut has largely been replaced by synthetic absorbable polymers such as Vicryl and
polydioxanone.
 It is not used at all for human surgery in some countries.
 In Europe and Japan, gut sutures have been banned due to concerns that they could transmit
bovine spongiform encephalopathy (mad-cow disease), although the herds from which gut is
harvested are certified BSE-free (Bovine Spongiform Encephalopathy).
Synonym
 Kit gut, surgical gut, collagen fibers

 Source-
 Catgut is a sterilized fiber or strand prepared from the collagen of connective tissues obtained from
healthy animals like sheep and cattle.
 PREPARATION
 The submucosal layer of small intestine of a freshly killed animal is used for the
preparation of catgut.
 About 7.5 m long intestine is cleaned and split longitudinally into ribbons.
 The innermost mucosa and two outer layers of the submucosa, muscular, and serosal
layers, are removed with the help of a machine, leaving behind the submucosa. Up to
six such ribbons are stretched, spun, and dried to form a uniform strand.
 These fibers are polished to get smooth strings, gauzed for their diameter, cut into
suitable lengths, and sterilized by placing the catgut in glass tubes filled with
anhydrous high-boiling liquids like toluene or xylene and then heating in an
autoclave. Sterilization may be done by irradiating the suture by electron particles or
by gamma rays from cobalt-60.
 Kangaroo tendons, used in hernia and bone repairs, are prepared from the tails
of kangaroo by the identical method adopted for the preparation of catgut
 Chromicized surgical catguts are prepared by soaking the ribbons in solutions
of chromium salts for tanning the tissues. These fibres are not affected by
proteolytic enzymes in the body and they are not absorbed rapidly in the body.
Uses
 used to hold body tissues together and approximate wound edges after an injury or
surgery
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