When asking for a suture generally three peices of information are included; suture size, suture type and

suture needle. For the suture pictured above, a surgeon would say, "Give me a 4-0 Vicryl on a PS-2". 4-0 (pronounced 4-oh) refers to the size of the suture fiber. Vicryl is the type of suture. And finally a PS-2 is the type of needle the suture is attached to.

Suture Size
Smallest 10-0 Typically used in the most delicate surgeries. Common in both Ophthalmic (eye) 9-0 surgery and for repairing small damaged nerves often due to lacerations in the 8-0 hand. 7-0 Used for repairing small vessels and arteries or for delicate facial plastic surgery. 6-0 Common for use in vascular graft sewing such a carotid endarterectomy. 5-0 Used for larger vessel repair such as an Abdominal Aortic Aneurysm or 4-0 skin closure.

3-0 Skin closure when there is a lot of tension on the tissue, closure of muscle layers 2-0 or repair of bowel in general surgery. 0 For closing of the fascia layer in abdominal surgery, the joint capsule in knee and 1 hip surgery or deep layers in back surgery. 2 For repair of tendons or other high tension structures in large orthopedic 5 surgeries. Largest

Suture Type
There are many different types of suture, the two most important properties are... Absorbable Vs Non-Absorbable and Braided Vs Non-Braided The Vicryl suture pictured above is an example of a braided absorbable suture.

Absorbable Suture
Absorbable suture breaks down over time in the body. Examples of absorbable suture include Monocryl, Vicryl, Chromic, and PDS. The amount of time it takes a suture to break down in the body depends on a few factors such as suture type, size and the location it is placed. The list to follow includes the most common absorbable sutures in most operating rooms listed from shortest to longest break down time. *Complete breakdown of strength times of various Ethicon Sutures: Vicryl Rapide 2 weeks Undyed Monocryl 3 weeks Dyed Monocryl 4 weeks Coated Vicryl 4 weeks PDS 9 weeks Panacryl 70 weeks Note Suture absorption rates can increase in patients with fever, infection or protein deficiency. Also, the strength to a suture will decrease significantly

prior to its complete breakdown time. Therefore a suture with higher tissue tension will have a greater chance of failure prior to the amount of time listed above

Non-Absorbable Suture
Nylon (Ethilon), Gortex, Silk, Fiberwire, Ethibond, Prolene and Steel are all example of non absorbable suture. When used on the skin, these sutures will be removed however when used in the body they will be retained inside the tissue. Common uses for non absorbable suture: Interrupted skin suturing when sutures will be removed later, 4-0 Nylon Securing drains to skin, 2-0 Silk Repair stitches for blood vessels, 6-0 Prolene Vessel graft stitches for AAA, Fem-Pop or Carotid Artery grafts 5-0, 6-0 prolene or gortex Bowel repair stitch, 3-0 silk Achilles Tendon Repair, #5 Ethibond or Fiberwire

Braided or Non-Braided Suture

Braided suture have a number of strands woven together like a string. Examples of braided suture are; Silk, Vicryl and Ethibond. Non-Braided or Monofilament Sutures have a single strand such as Monocryl, PDS,and Ethilon Nylon. Often times it will be surgeon preference when choosing a braided or nonbraided suture. 4-0 vicryl and 4-0 monocryl are by far the most common sutures used from sewing the skin. Both are absorbable however vicryl is braided and monocryl is non-braided. It is thought that non-braided sutures cause less reactivity in the body and are not as prone to becoming infected because they lack the grooves and rough surface for things to adhere. However non-braided sutures can have a greater tendency to loosen at the surgical knot with the lack of grip.

Suture Needles
Along with selecting the correct suture it is important as well to select an appropriate needle. The two factors in selecting a needle are size and if a cutting or tapered needle is needed.

While there are exceptions, much of the time you will find tapered needles are used inside the body such as on bowel, fascia, or muscle where the tissue is more easily pierced. Cutting needles are used for skin and very tough tissue such as bone and tendon. Beyond choosing a cutting or tapered needle one only needs to select an appropriate size. There are hundreds of sizes and types of needles. Listed below are some of the most common used in most typical surgical procedures.

Tapered Suture Needles

TP or CTX Used for closing fascia during abdominal surgery. CT or CT1- For closing the joint space in knee and hip surgery or deep tissue layers after closing the fascia in general surgery. CT2 - Often used on the uterus in OB Gyn procedures. SH Used to stitch the bowel or close layers of tissue in breast surgery. CV or BV Used for vessels and nerve repair, very small and delicate and often used with a Castro Viejo needle holder.

Cutting Suture Needles

FSLX - Large skin closure when a lot of tension is present common for retention sutures or large orthopedic use. FSL Often used for sewing in drains or skin closure needing higher tension closure. FS2 or PS2 - For common skin closure. P3 Used for skin closure of small incisions such as hand surgery or facial plastic surgery.

Suture Name - Chromic Construction - Monofilament Strength - 21-28 days Absorption - 90 Days Color - Brown or Blue Dyed Additional Info - Chromic suture is made from either beef serosa or sheep submucosa. It is most commonly used in OB-GYN surgery and facial plasic or oral surgery.

Suture Name - Silk Construction - Braided Absorption - Non-Absorbable Color - Black Additional Info - Commonly used to tie in surgical drains, repair small holes in the bowel or tie off large blood vessels.

Suture Name - Ethibond Construction - Braided Absorption - Non-Absorbable Color - Dyed Green Additional Info - Most commonly used in orthopedic surgery to reconnect high tension tissue. A #5 Ethibond suture, the largest, can be used to repair a ruptured Achilles tendon.

Suture Name - Gortex Construction - Monofilament Absorption - Non-Absorbable Color - White Additional Info - Common uses for gortex suture would be for suturing the anastomosis of cardiac or vascular grafts, or to suture a gortex patch in a ventral hernia repair.

Suture Name - Monocryl Construction - Monofilament Strength - 50%-70% 1 week, 20% - 40% @ 2 weeks Absorption - 91-119 Days Color - Violet or Undyed Clear Additional Info - One of the most common sutures used in all surgical services for skin clossure, also used commonly in cosmetic surgery for general soft tissue closure.

Suture Name - Nylon Ethilon Construction - Monofilament Absorption - Non-Absorbable Color - Black, Green or Clear Additional Info - Most commonly used for suturing the skin when using an interupted stitch, sewing in a surgical drain, and very small Ethilon sutures are used for reparing lacerated nerves or blood vessels

Suture Name - PDS Construction - Monofilament Strength - Size 4-0 and smaller 60% @ 2 weeks, 40% @ 4 weeks, and 35% @ 6 weeks Size 3-0 and larger 80% @ 2 weeks, 70% @ 4 weeks, and 60% @ 6 weeks Absorption - 183 - 238 days Color - Clear or Violet Additional Info - PDS is a long lasting absorbable monofilament suture for soft tissue approximation, it is commonly used to approximate fascia in open abdominal cases.