DISCUSS SUTURES IN

SURGICAL PRACTICE

Dr. Oke R. Obadaseraye

Consultant Orthopaedic surgeon
09/04/2025
04/09/2025
OUTLINE
INTRODUCTION
CHARACTERISTICS OF SUTURES
CLASSIFICATION OF SUTURES
CLINICAL CONSIDERATIONS
NEEDLES
DISADVANTAGES OF SUTURES
ALTERNATIVES
CONCLUSION
REFERENCES

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INTRODUCTION
A suture is a biomaterial device, natural
or synthetic, used to ligate blood vessels
and approximate tissues together.

A material used to hold wound together

in good apposition until a time when the
natural healing process is well
established that the such material is
unnecessary and redundant.
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Introduction
Sutures have undergone evolution over time
to the current day sutures.
Different sutures with different
characteristics exist.
The have also been classified on various
bases.
Good knowledge of their properties is
important to all clinicians and more
importantly, the surgeon.
Good surgical technique is more important
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Historical perspectives
The earliest reports of surgical suture dates
back to 3000 BC in ancient Egypt
Oldest known suture is in a mummy from
1100 BC
The Indian sage and physician Sushruta, in
500 BC, described wound suture and the
material used.
Catgut suture along with the surgery needle
developed by Abulcasis in the 10th century

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History
Joseph Lister in the 1860s first attempted
sterilization with the "carbolic catgut,"
Chromic catgut followed two decades
later.
Sterile catgut was finally achieved in
1906 with iodine treatment.
Synthetic sutures began in 1930s
Later the process of sterilization with
ethylene oxide and gamma irradiation
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Uses of sutures
Tissue approximation
Wound and dead space closure
Blood vessel ligation
Retraction
Anchorage of implants like mesh
Anchorage of drains
Markers

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Properties of sutures
Configuration Tissue reaction
Diameter/ size Handling
Tensile strength characteristics
Knot security Antibacterial
Elasticity properties
Plasticity
Memory

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Properties of sutures
CONFIGURATION
This is based on the number of strands used
to fabricate the suture
Monofilamentous
Multifilamentous (braided or twisted)

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DIAMETER (SIZE)

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 Properties of sutures
TENSILE STRENGTH
The tensile strength of a material is the maximal
stress that it can withstand before breaking
Breaking strength is the force necessary to
break a suture regardless of the diameter

 KNOT SECURITY
Knot strength is defined by the force necessary
to cause slippage.
Knot security is defined as the ability of a knot to
resist slippage and breakage as load is applied.

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Properties of sutures
 ELASTICITY
Elasticity is the ability of a suture to regain
its original form and length after stretching.
PLASTICITY
Plasticity is the ability of the suture to retain
its new form and length after stretching.
Plasticity allows a suture to accommodate
wound swelling

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Properties of sutures
MEMORY
Memory is the ability of a suture to return to
its original shape after deformation by tying.
 Memory is related to plasticity and elastic
TISSUE REACTION
Determined by suture material, capillarity,
mechanism of suture absorption and size
Capillarity is the ability to absorb and retain
fluid or microbes

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Properties of sutures
HANDLING CHARACTERISTICS
Pliability
This refers to the ease with which a suture can be
bent

Coefficient of friction
A measure of the slipperiness of a suture.
The more the coefficient of friction the more
difficult
pass through tissues.

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Properties of sutures
ANTIBACTERIAL PROPERTIES
Antimicrobial coated sutures are thought to
help reduce surgical site infections
Example is the triclosan coated vicryl (vicryl
plus)

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Properties of sutures
ABSORPTION
Absorbable or non absorbable
Absorbable sutures undergo degradation in
tissues losing their tensile strength
Loose tensile strength within 60 days
Mechanism is either by hydrolysis or
enzymatic degradation(proteolysis)
Non-absorbable sutures are defined by their
resistance to degradation by living tissues.

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Qualities of an ideal suture
1. Strong
2. Inert
3. Safe
4. Easy to handle
5. Good knot security
6. Affordable
7. Sterile

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CLASSIFICATION
Absorbability

Absorbable

Non absorbable

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Absorbable sutures
(Natural)
Catgut
First absorbable suture, made from twisted
fibres of collagen derived from gut
Usually packaged in alcohol to prevent drying
and breaking
 3 forms are available
Plain
Chromic and
Fast-absorbing

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Absorbable sutures
(Natural)
Maintains its tensile strength for only 7-10
days after implantation.
Completely absorbed by 70 days.
Chromic catgut is plain catgut treated with
chromic salt to decrease absorption and
reactivity
Tensile strength maintained up to 10-21 days
Complete absorption does not occur until at
least day 90.

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Absorbable sutures
(Natural)
Fast absorbing catgut
Plain gut treated with heat to facilitate more
rapid absorption
Completely absorbed within 2-4 weeks.
Maintains its tensile strength for only 5-7
days.
Useful for facial wounds under low tension.
 Useful for securing both split- and full-
thickness skin grafts.

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 Absorbable sutures(Synthetic)
Polyglycolic acid (Dexon)
Polyglactin (vicryl)
Polydioxanone
Polytrimethylene carbonate or polyglyconate
Poliglecaprone
others
Glycomer 631
Polyglytone 6211

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Polyglactin
Introduced in 1974
Braided, good handling, allows easy knot
tying
Retains 60% tensile strength at day 14 and
only 8% at day 28.
Completely hydrolyzed by 60-90 days
Vicryl is polyglactin 910 coated with
polyglactin 370 and calcium stearate to
reduce tissue drag.
This compromised knot security
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Non absorbable(Natural)
Silk
Formed from the protein fibers produced by
silkworm larvae.
Braided,considered non absorbable but
degrades over 2 years
Excellent handling and knot-tying properties
Pliable with low memory
Does not tear through tissue
Low tensile strength, high tissue reaction

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Non absorbable (synthetic)
Polyamide (Nylon)
Polyester
Polypropylene(Prolene)
Polybutester

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Non absorbable (synthetic)
Nylon
First synthetic suture, 1940.
Available in monofilamentous and braided forms.
High tensile strength
Non-absorbable, it loses tensile strength when
buried in tissue.
 Monofilament nylon is stiff; therefore, handling
and tying are difficult and knot security is low
Braided forms have better handling properties
but greater tissue reactivity and cost.

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CLINICAL CONSIDERATIONS:
Suture selection
The optimal suture size is the smallest size
that can still effectively achieve the desired
tension-free closure.
The tensile strength of suture versus tissue
Loss of suture strength vs gain by tissue
Tissue type
Non absorbable sutures for slow healing
tissues

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Suture selection
Absorbable sutures for rapidly healing
tissues, vessels
Absorbable sutures for tissues where tension
is low
Smaller sutures are generally preferred for
cosmesis
Monofilament sutures better for potentially
contaminated tissues
Natural sutures not advisable in the gut due
to digestion
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NEEDLES:
Basic design of needle

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Types of needles
Straight needle
4 types of curved needle
Round
Conventional-cutting,
Reverse-cutting,
Spatulated

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Qualities

of ideal needle
High-quality stainless steel,
Sharp
Rigid
Malleable.
Small diameter
Stable in the grasp of a needle holder.

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Choosing a needle
Tissue type Length
Tissue thickness Diameter
Location Curvature of the
Cosmesis needle
Suture size
Cost

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Disadvantages of sutures
Nidus of latent infection
Foreign body sensation
Site for stone formation (in urinary bladder
or gall bladder)
Site of formation of anastomotic ulcer
Herniation/ extrusion

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ALTERNATIVES
Staples
Tapes
Tissue adhesives

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Staples
Made of high-quality stainless steel and has 3
parts
1. Cross-member that lays on the surface of the
skin perpendicular to the wound,
2. Legs that are vertically placed in the skin
3. Tips that secure the staple parallel to the
cross-member.
 Uses
closure of wounds under low tension on the
trunk, extremities, and scalp.
 secure split-thickness skin grafts.
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Tapes
Tapes are strips of microporous nonocclusive
material (eg, paper, plastic, rayon fabric)
backed by a thin film of acrylic polymer
adhesive.
Useful as an adjunct to or a substitute for
other wound closure materials.
Can also be used alone for wounds that are
small, non-exudative, and under minimal
tension.

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Tissue adhesive
Cyanoacrylates (glue)
Require approximation of tissues before
application
Impaired healing occurs when adhesive seeps
into the wound

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Conclusion
Sutures have undergone tremendous
development over time
Various sutures possess different properties
to suit different body tissues
The surgeon must be familiar with these
variations to choose the appropriate closure
material.

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References
Norman S.W, Christopher J.K.B, Ronan P.O.
Bailey and Love’s Short Practice of Surgery. 25 th
edition. London, UK 2008.
Sriram B.M. SRB’s Manual of Surgery 4 th
edition. India. 2013.
Ellen S.S. Joseph A.M. medscape. USA. [Updated
Aug 14, 2017]. June 24, 2020.
emedicine.medscape.com
Rose J, Tuma F. Sutures and needles.[updated
2019 Mar 13]. In:StatPearls[Internet]. Treasure
Island(FL):StatPearls Publishing; 2020 Jan.
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 Thank you for
listening
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