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General Information

If an ideal suture material could be created, it would be :

  • Highly uniform tensile strength, permitting use of finer sizes
  • High tensile strength retention in vivo, holding the wound securely throughout the critical healing period, followed by rapid absorption
  • Consistent uniform diameter
  • Predictable performance
  • Non-capillary, non-allergenic, and non-carcinogenic
  • Easy to handle, ties down well, provides optimum knot security
  • Minimally reactive in tissue and not predisposed to bacterial growth
  • Capable of holding tissue layers throughout the critical wound healing period securely when knotted without fraying or cutting
  • Resistant to shrinking in tissues
  • Absorbed completely with minimal tissue reaction after serving its purpose

However, because the ideal all-purpose suture does not yet exist, the surgeon must select a suture that is at least as close to the ideal as possible

Personal Suture Preference :

Most surgeons have a basic “suture routine,” a preference for using the same material(s) unless circumstances dictate otherwise. The surgeon acquires skill, proficiency and speeds in handling by using one suture material repeatedly– and may choose the same material throughout his or her entire career

A number of factors may influence the choice of materials :


  • His or her area of specialization
  • Wound closure experience during clinical training
  • Professional experience in the operating room
  • Knowledge of the healing characteristics of tissues and organs
  • Knowledge of the physical and biological characteristics of various suture materials
  • Patient factors (age, weight, overall health status and the presence of infection)


Size and Tensile Strength :

Size denotes the diameter of the suture material

The accepted surgical practice is to use the smallest diameter suture that will adequately hold the mending wounded tissue

This practice minimizes trauma as the suture is passed through the tissue to effect closure. It also ensures that the minimum mass of the foreign material is left in the body

Suture size is stated numerically; as the number of 0’s in the suture size increases, the diameter of the strand decreases. For example, size 5-0, or 00000, is smaller in diameter than size 4-0, or 0000. The smaller the size – the less tensile strength

The suture will have knot tensile strength is measured by the force, in Kilograms force (Kgf), which the suture strand can withstand before it breaks when knotted

The tensile strength of the tissue to be mended (its ability to withstand stress) determines the size and tensile strength of the suturing material the surgeon selects

The accepted rule is that the tensile strength of the suture need never exceed the tensile strength of the tissue. However, sutures should be at least as strong as normal tissue through which they are being placed

If the tissue reduces suture strength over time, the relative rates at which the suture loses strength and the wound gains strength are important

If the suture biologically alters the healing process, these changes must also be understood

Monofilament vs. Multifilament Strands :

Sutures are classified according to the number or strands of which they are comprised

Monofilament sutures are made of a single strand of material

Because of their simplified structure, they encounter less resistance as they pass through tissue than multifilament suture material

They also resist harboring organisms which may cause suture line infection

These characteristics make monofilament sutures well-suited to vascular surgery

E.g. : Polyamide (Nylon), Polypropylene

Multifilament sutures consist of several filaments, or strands, twisted or braided together. This affords greater tensile strength, pliability, and flexibility

Multifilament sutures may also be coated to help them pass relatively smoothly through tissue and enhance handling characteristics

E.g.: Polyglycolic Acid (PGA), Silk, Polyester

Note : Catgut is multifilament in construction, however due to polishing gives a finish of Monofilament


Absorbable suturesmay be used to hold wound edges in approximation temporarily, until they have healed sufficiently to withstand normal stress

Natural Absorbable sutures :

These sutures are prepared either from the collagen of healthy mammals

Some are absorbed rapidly, while others are treated or chemically structured to lengthen absorption time (Chromic)

Absorbed / digested by body enzymes which attack and break down the suture strand

Plain sutures are absorbed in 70 days measurable tensile strength for 7-10 days

Chromic sutures are absorbed in over 90 days with measurable tensile strength for 14-21 days


Synthetic Absorbable sutures :

They are made of polymer strands which are braided and impregnated or coated with agents that improve their handling properties and colored with an FDA approved dyes to increase visibility in tissue

Synthetic absorbable sutures are hydrolyzed — a process by which water gradually penetrates the suture filaments, causing the breakdown of the suture’s polymer chain

Absorption normally completes in 60-90 days

Compared to the enzymatic action of natural absorbable, hydroxylation results in a lesser degree of tissue reaction following implantation

Varieties of Synthetic Absorbable sutures – Polyglycolic Acid (PGA) Fast Absorbing (SURUCRYL INSTA™), Polyglycolic Acid (PGA) (SURUCRYL®), Polyglactin 910 (PLA) Suture (SURUCRYL 910™), Monofilament Poliglecaprone 25 Suture (SURUGLYDE™), Monofilament Polydioxanone Suture (SURUSYNTH™)


Non absorbable Materials :

Non-absorbable sutures are those, which are not digested by body enzymes or hydrolyzed in body tissue they may be used in a variety of applications :


  • Exterior skin closure – to be removed after sufficient healing has occurred
  • Within the body cavity, where they will remain permanently encapsulated in tissue
  • Patient history of reaction to absorbable sutures, keloid tendency or possible tissue hypertrophy
  • Prosthesis attachment (i.e., defibrillators, pacemakers, drug delivery mechanisms)
  • Where lifelong support is required like in cardiovascular surgeries
  • These sutures may be uncoated or coated, uncolored or naturally colored or dyed with FDA approved dyes to enhance visibility



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