SUTURES & LIGATURE
MATERIALS
-SEMINAR, 22nd MARCH 2023
The suture is a strand or thread, used to ligate (tie) blood vessels or to
approximate (sew) damaged tissues together.
Sutures are classified on basis of,
Absorbable
● Behavior of suture material
Non-absorbable
● Number of strands Monofilament
Polyfilament
● Source
Synthetic
Natural
Absorbable sutures-either by enzyme or phagocytosis
● Natural absorbable-
plain and chromic catgut
● Synthetic absorbable-
Polyglycolic acid(dexon)
Polyglactin 910(vicryl)
Polyglactin 910 rapid(vicryl rapid)
Polydioxanone suture (PDS)
Polyglecapron 25 (monocryl)
Non-absorbable sutures: for indefinite period.
● Natural non-absorbable sutures: -
Linen thread
Silk
● Synthetic non-absorbable sutures: -
polypropylene(prolene)
Monofilament polyamide(ethilon)
polyester(ethibond)
nylon
Strands
Monofilament Polyfilament
Single strands Multiple strands, braided together.
Smooth and strong Easier to handle. Knot tied does not slip.
Chance of bacterial contamination less.
Knot tied may become loose.
Bacterial contamination.
Prolene, ethilon ,catgut, monocryl, pds
Silk, linen,polyglycolic acid, vicry.
Polyglactin dinner sizes 6/0,9/0
Ideal suture material
● Adequate tensile strength
● Incite minimal tissue reaction
● Easy handling property
● Good knotting quality
● Non-allergenic and noncarcinogenic
● Easily available and cheap.
CATGUT
The natural absorbable surgical suture derived from the submucosa of the sheep is known as catgut.
This is the brand name of this suture manufactured by Ethicon division of Johnson and Johnson. The
similar sutures manufactured by other companies includes Trugut, Pro Gut, etc.
99% COLLAGEN
RULE FOR PLAIN CATGUT- 50-3-ALL-15 GET ABSORBED IN 60 DAYS.
RULE FOR CHROMIC CATGUT 50-7-ALL-28 GET ABSORBED IN 90 DAYS
In presence of infection the catgut gets absorbed earlier.
USE:
PLAIN CATGUT
CHROMIC CATGUT
Small subcut vessels
Subcut tissue Muscles,bowel anastomosis,closure of
During circumcision for cut margin peritoneum.
Repair wound of lips and oral cavity. During appendectomy
During cholecystectomy
Atraumatic sutures. ? STERILISED BY
GAMMA
CATGUT IRRADIATION
SUPPLIED IN
HOW TO STERILISED PACK
MERSUTURE PREPARED? CONTAINING
ISOPROPYL
20% ALCOHOL.
Submucosa of sheeps
and serosa of beefs
intestine.
Synthetic absorbable sutures
● In lab.
● Can be monofilament (e.g monocryl) or polyfilament (eg vicryl)
● Can be with natural color or green color (dexon) or violet color(vicryl).
● Strength almost twice as natural absorbable sutures.
● Absorbed by simple process of hydrolysis and evoke minimal tissue reaction.
● They have excellent handling properties.once tied the knot are secured.
● Sterilised by ethylene oxide.
●
2 vicryl / polyglactin sutures
● Synthetic absorbable sutures.
● Vicryl - a trade name of polyglactin 90 by ethicon (Johnson and Johnson).
● Can be round body, cutting or taper cut.
● Can be undyed vicryl and coated vicryl.
● Co-polymer of lactide and glycolide.(1:9)
Characteristics
● Polyfilamentous sutures but finer ones are monofilamentous.(eg 5-0,6-0)
● Maintains tensile strength in the tissue for about 28-30 days and get absorbed
in 80-90 days.
Uses of polyglycolic acid and polyglactin sutures.
● Indicated in all situation ~catgut.
● No. 1 or 1-0 suture may be used for closure of subcostal, paramedian,mc
burney’s incision.
● 3-0 or 4-0 sutures (atraumatic) - biliary enteric
anastomosis(choledocoduodenostomy) , choledoco-jejunostomy.
● In small gut resection anastomosis-seromuscular (anterio and posterior) may
be sutured with 2-0 polyglactin or polyglycolic acid sutures.
● Single layered anastomosis in large gut may be done with 2-0 polyglactin or
polyglycolic acid suture.
Polyglactin rapide (vicryl rapide) sutures.
Characteristics:
● Variety of vicryl .
● Rapid absorption.
● By exposure of coated vicryl to gamma radiation. Which results in material
low in molecular weight than coated vicryl.
● Tensile strength for 10-12 days and get absorbed in 42 days.
Uses:
● May be used for subcuticular sutures, skin , mucosal closure.
● Need not remove , spontaneously absorbed.
Polyglecaprone (Monocryl suture )
● Synthetic absorbable monofilament
● Co-polymer of glycolide and caprolactone(3:1)
● Double the strength of chromic catgut.
● Excellent handling properties , has got very smooth surface and passes
through the tissue with greater ease.
Uses:
● ~catgut used
● Can be used for intestinal anastomosis as an alternative to catgut and
polyglactin.
● Subcutaneous tissue apposition.
● Used in Uro surgeries-pyeloplasty, ureter repair.
Polydioxanone Suture (PDS-II)
● Synthetic delayed absorbable monofilament
● Formed by polymerizing the monomer “paradioxanone”
● Dyed violet. PDS II sutures are an improved version of initial PDS suture.
● Soft,pliable and smooth PDS II allows easy passage through the tissues and
knotting characteristics —-Best among the synthetic absorbable sutures.
● Tensile strength for longer period 56 days
2 wks-50% maintained
6 wks-25%
8wks-loses all tensile strength.
Suture is absorbed by hydrolysis and complete absorption in about 180-210 days .
Uses:
-No 1 or 1-0 suture can be used for closure of paramedian or midline and other
abdominal incision .
-3-0 and 4-0 sutures are used for intestinal or biliary enteric anatomosis.
-~all situation where catgut, polyglycolic and polyglactin.
Silk
● Natural non absorbable sutures.
● Supplied in sterile pack or nonsterile as silk reel of varying sizes.
Characteristics:
● Derived from cocoon of silk worm larvae.
● Manufacturing : Basically a protein covered initially by an albuminous layer. The
albuminous layer is removed by a process called degumming during manufacturing
of these sutures. The suture is braided round a core and coated with wax to reduce
the capillary action.
● Handling property is best and it knots securely
● Sterilized by gamma irradiation.
● The silk for surgical use is dyed black .
● Silk maintains tensile strength for a longer time and the tensile strength is lost in 2
years time.
● Once placed in the tissues it incites a polymorphonuclear reaction and a fibrous
capsule is formed around the silk in 14–21 days.
Uses of silk suture:
● No. 1 or 1-0 silk sutures are used as ligature:
-Used during cholecystectomy to ligate the cystic duct and cystic artery .
- Used during small and large gut resection to ligate the mesenteric vessels.
-Used to ligate the pedicles during nephrectomy and splenectomy -
-Used during truncal vagotomy to ligate the anterior and posterior vagus
nerve before their division. Two ligatures are applied and the nerve is
divided in between.
-Used for skin closure either with interrupted or continuous suture
