for medical students

1. Suture Materials
&
Basic Suturing Technique
Dr Bijendra Shah
M.S.(Ayu), FARCS(Anorectal)
Teaching Assistant -ACTH-IOM,TU

2. Suture Materials

3. Introduction
 Suture means to ‘sew’ or ‘seam’.
 In surgery suture is the act of sewing or bringing tissue
together and holding them in apposition until healing
has taken place.
 A suture is a strand of material used to ligate blood
vessels and to approximate tissues together.
 Suture material is an artificial fiber used to keep wound
together until they hold sufficiently well by themselves
by natural fiber (collagen) which is synthesized and
woven into a stronger scar

4. CHARACTERISTICS OF AN IDEAL SUTURE
Ideal suture material should:
1. Have good handling characteristics
2. Not induce significant tissue reaction
3. Allow secure knots
4. Have adequate tensile strength
5. Not cut through tissue
6. Be sterile
7. Be non-electrolytic
8. Be non-allergenic
9. Cheap

5. GOALS OF SUTURING
Suturing is performed to
Provide adequate tension
Maintain hemostasis
Permit primary intention healing
Provide support for tissue margins
Reduce post-operative pain
Prevent bone exposure
Permit proper flap position

6. CLASSIFICATION OF SUTURE MATERIALS
I. According to source
1. Natural :-
Catgut, Silk, Cotton, Linen
2. Synthetic :-
Vicryl, Dexon, Polydioxanone suture(PDS),
Maxon, Polypropylene, Polyethylene,
Polyester, Polyamide.
3. Metallic :-
Tantalum, Gold, Silver, Aluminium, SS

7. II. According to structure
1. Monofilament :-
Polydioxanone suture(PDS), Catgut,
Polypropylene, Polyethylene, Steel.
1. Multifilament :-
Vicryl, Dexon, Silk, Cotton, Polyester,
Polyamide.

9. III. According to fate:
1. Absorbable :- Natural
 Catgut :- Submucus of jejunum of sheep, yellowish
white, Absorbed by inflammatory reaction &
phagocytosis, abs.-7days, use- subcutaneous
tissue, muscle, circumcision in children
 Chromic catgut:- with chromic acid salt, brown ,
abs- 21 days, use- muscle, fascia, external o.
aponeurosis, ligating pedicles.
 Collagen Fascia
 kangaroo tendon
 Beef tendon

10. Synthetic
Dexon (Polyglycolic Acid)
Polyglactic Acid
Polyglactin 910(Vicryl):- Braided, synthetic,
absorbable, abs-90days, violet in colour, abs.
by hydrolysis, good for bowel anastomosis,
suturing muscles, closure of peritoneum.
Polydioxanone(PDS) :- creamy, better material
than vicryl
Polyglecaprone

11. Non absorbable
Natural:-
• Silk • Linen • Cotton • Ramie • Horse hair
Synthetic:-
 Nylon/ polyamide
 PolyPropylene (prolene):- monofilament, Blue , highy
memory.
 Polyesters
 Polyethyelene (Ethylene):- monofilament , black in
colour,
 Polybutester Polyvinylidene fluoride / PVDF Sutures

12. IV. Classification:
1. Braided:-
Vicryl, Dexon, Silk, Cotton, Polyester,
Polyamide.
2. Twisted:-
Cotton , Linen
V. According to coating:
1. Coated
2. Uncoated

16. Numbering of suture material
2 – Thick – for pedicle ligation
1-
0-0
1-0
2-0 – for bowel suturing
3-0
4-0
5-0 – for vascular anastomosis
6-0
7-0
8-0
9-0 – for ophthalmic surgery

17. Types of Suturing
• Continuous/running suture
• Interrupted sutures
• Continuous subcuticular suture
• Mattress sutures
• Purse string suture

18. Continuous/running suture
The continuous suture as its name suggests, it is very quick only has a knot at
the beginning and the end

19. Interrupted sutures
This suture is used for simple laceration closures or closure of
office procedures like biopsies or lesion removals and used
inside the wound to close deep sutures

20. C. subcuticular suture
Used for cosmetic
closures

21. Mattress sutures
H.M. Used with wounds with poor circulation, Helps eliminate
tension on wound edges, V.M. Deep and shallow approximation of
the tissue, Can be useful with lax tissue e.g. elbow and knee
Should not be used on volar surface of hands or feet or on the
face because of blind placement of the deep part of the suture

22. Purse string suture
The purse-string suture (PSS) is a technique that can be used to reduce
the surface area of circular wounds in an effort to obtain minimal scarring.

23. Types of Knots

25. Thank You