BASICS OF SURGICAL SUTURES

(Lifted from: ETHICON SUTURES Product Overview 04.02.09 Asian Hospital and Medical
Center)
Suture
Any strand of material used to LIGATE (TIE) blood vessels or APPROXIMATE (SEW)
tissues
IDEAL

Suture:
Sterile
Easy handling
Minimal tissue reaction/trauma
High tensile strength and retention
Hold knot securely
Absorbed after serving purpose in wound culture
Used in any procedure

Suture Classification:
Absorbability
A. Absorbable
B. Non-absorbable
For exterior skin closure, can be removed after healing
History of reaction to absorbable sutures
Prosthesis
Origin
A. Natural
If absorbable, absorbed by ENZYMATIC PROCESS
B. Synthetic
Predictable absorption with minimal tissue reaction
If absorbable, absorbed by HYDROLYSIS
Filament
A. Monofilament
Less traumatic
Resist harboring microbes
B. Braided
Greater tensile strength, pliability and flexibility
Suture Sizes
Balance between lessening reaction and strength to prevent dehiscense
Suture Types
A. Absorbable
a. Natural
i. Plain Gut
Collagen, submucosal or serosal layer of animal intestine

Monofilament
Packed wet to keep supple and pliable
Wound Support 7-10 days
Absorption 60-90 days

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 Unpredictable absorption with tissue reactions

ii. Chromic Gut
Same with Plain Gut but underwent Chromicizing Process
Wound Support 17-21 days
Absorption 90-110 days
Unpredictable absorption with tissue reactions
b. Synthetic
i. Vicryl Rapide
Polyglactin 910
Initial strength like silk
Predictable absorption with minimal tissue reaction
Braided
Coated for smooth tissue passage, easy knot management and
minimal problems with braiding
Wound Support 10 days
Absorption 42 days
ii. Vicryl Plus
Polyglactin + Triclosan
Effective against common cause of surgical site infections: S.
aureus, S. epidermides, MRSA, MRSE.
Coated for smooth tissue passage and easy knot management;
Triclosan not removed in fluids
Monofilament
iii. Monocryl
Poliglecaprone 25
Monofilament
Predictable absorption with minimal tissue reaction
Wound Support 21-28 days
a. Undyed 21 days. Initial strength is double of chromic
catgut
b. Dyed 28 days
Absorption 91-119 days
iv. PDS II
Polydioxanone
Monofilament
Wound Support 60 days
Absorption 180-210 days
B. Non- Absorbable
a. Natural
i. Silk
Braided
Very good knotting and handling
Wax proofing to improve surface quality, reduce bacterial harbor
and reduce capillarity
Has tissue reactions, losses strength, eventually fragments
b. Synthetic
i. Ethilon
Polyamide 666
Monofilament
Mainly for skin and abdominal closure. Can also be for ophthalmic
and microsurgery

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 Smooth, easy passage

No bacterial harbors or capillarity
Strong, controlled elasticity for ultra fine gauges
Nylon absorbs water, losses strength at 15-20% per year
ii. Ethibond Excel
Polyester
Multifilament
Coated with polybutilate to reduce bacterial harbors and capillarity,
provide smooth passage
Ideal for heart valve replacement
iii. Prolene
Polypropylene
Monofilament to replace nylon
Knots lock easily
Smoothest suture surface
Major uses:
a. Continuous sutures requiring adjustment
b. Standard for vascular surgery
c. Skin and Subcuticular for painless withdrawal
iv. Stainless Steel
Major Uses:
a. Sternum closure
b. Rotating needle for sternum sutures
c. Trochanteric reattachment
d. Pull out tendon sutures
e. Cardiac pacing wires
Mono or Multifilament
Surgical Needles
Needle Anatomy
Point
Body
Swage
Needle Swage
A. Classified by the swage:
a. Closed eye
b. French eye
c. Swage hole drilled creating a channel within
B. Advantage:
a. No need to select needles
b. Minimal preparation
c. Less tissue trauma
d. New and sharp needle each time
e. If needle is dropped into cavity, can be easily found
C. Types:
a. Single armed one needle
b. Double armed two needles, one at each end
c. Loop one needle swaged to a loop
Body of Needle
The deeper the area, the greater curvature needed less pronation and deeper bite

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circle eye and microsurgery

3/8 circle Large and superficial wounds
circle confined locations
5/8 circle urology and deep cavity

Point of the Needle

A. Conventional Cutting
a. Cutting on the inside
b. Flattened sides to reduce bending
c. Flattened in the needle grasping area
B. Reverse Cutting
a. Cutting on outside
b. Tissue cut out greatly reduced
c. Wide wall of tissue against suture
C. Taper Point
a. Pierce and spread tissue without cutting
b. Preferred when smallest possible hole in the tissue and minimal tissue cutting
desired
c. Major Use:
i. Intestinal anastomosis
ii. Fascia closure
iii. Gynecology
iv. Hernia
v. Cardiovascular surgeries
D. Tapercut Trocar Point
a. Combined reverse cutting edge and taper point body
b. Initially for cardiovascular surgery
E. Spatula
a. Flat on both top and bottom
b. Side cutting edges for ophthalmic procedures
c. Permit needle to separate through thin layers of sclera or corneal tissue
F. CS Ultima
a. Corneal Scleral needle
b. Sharpest needle in this category
G. Blunt Point
a. Pierce and spread tissue without cutting
b. For friable tissues like liver, spleen, kidney
c. For safety reasons, also used in gynecology and others

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