Suture MaterialsSuture Materials

HISTORY OF SUTURESHISTORY OF SUTURES

Earliest ReferenceEarliest ReferenceEDWIN SMITH PAPYRUS 1600 BCEDWIN SMITH PAPYRUS 1600 BC

GALEN AD 150 ON CATGUTGALEN AD 150 ON CATGUTLISTER CARBOLISED CATGUTLISTER CARBOLISED CATGUT

SUTURE IS A STRAND OF ANY MATERIAL SUTURE IS A STRAND OF ANY MATERIAL USED FORUSED FOR

• Ligating Blood vesselsLigating Blood vessels

• TransfixingTransfixing

• Approximating tissuesApproximating tissues

THE IDEAL SUTURETHE IDEAL SUTUREMoynihan 1912Moynihan 1912

• MonofilamentMonofilament• AbsorbableAbsorbable• Predictable absorptionPredictable absorption• Use for any ProcedureUse for any Procedure• Easy to handleEasy to handle• Minimal Tissue ReactionMinimal Tissue Reaction• High Breaking StrengthHigh Breaking Strength• Holds Knots SecurelyHolds Knots Securely• SterileSterile

Choice of sutureChoice of suture

• FamiliarityFamiliarity

• Ease of handlingEase of handling

• Tissue characteristicsTissue characteristics

• Knowledge of physical and biological Knowledge of physical and biological characteristics of the suturecharacteristics of the suture

• Patient factors-Patient factors-infection,debility,obesityinfection,debility,obesity

CLASSIFICATION OF SUTURESCLASSIFICATION OF SUTURES

ABSORBABLE NONABSORBABLE

MONOFILAMENT BRAIDED

SYNTHETIC NATURAL

CLASSIFICATION OF SUTURES

Natural

Synthetic

PROLENE*

Silk

ETHIBOND*

Stainless Steel

ETHILON*

Natural

Synthetic

Plain/F.A. Gut

Chromic Gut

VICRYL*

MONOCRYL*

VICRYL* Rapide

PDS II*

ABSORBABLE SUTURES NON - ABSORBABLE SUTURES

ABSORBABLEABSORBABLE

ADVANTAGEADVANTAGE– Broken down by bodyBroken down by body– No Foreign body leftNo Foreign body left

DISADVANTAGEDISADVANTAGE– Time of Wound SupportTime of Wound Support

NONABSORBABALENONABSORBABALE

ADVANTAGEADVANTAGE– Permanent Wound SupportPermanent Wound Support

DISADVANTAGEDISADVANTAGE– Foreign body leftForeign body left– Suture SinusSuture Sinus– Suture ExtrusionSuture Extrusion

MONOFILAMENTMONOFILAMENT

ADVANTAGEADVANTAGE– Smooth SurfaceSmooth Surface– Low FrictionLow Friction– Less DragLess Drag– Less Tissue TraumaLess Tissue Trauma– Less Tissue InfectionLess Tissue Infection– No CapillarityNo Capillarity

MONOFILAMENTMONOFILAMENT

DISADVANTAGEDISADVANTAGE

– Handling and KnottingHandling and Knotting– Stretch ability and bending-Stretch ability and bending-

PLIABILTYPLIABILTY

BRAIDEDBRAIDED

ADVANTAGEADVANTAGE– StrengthStrength– Soft and PliableSoft and Pliable– Good HandlingGood Handling

BRAIDEDBRAIDED

DISADVANTAGEDISADVANTAGE

-Capillary Action-Capillary Action

-Tissue Trauma-Tissue Trauma

-Tissue Drag-Tissue Drag

-Tissue Cutting-Tissue Cutting

-Harbors bacteria-Harbors bacteria

In vivo performance of In vivo performance of absorbable suturesabsorbable sutures

• tensile strength retentiontensile strength retention

• Absorption rateAbsorption rate

CATGUTCATGUT

• 99% PURIFIED COLLAGEN FROM 99% PURIFIED COLLAGEN FROM SUBMUCOSA OF SHEEP INTESTINESUBMUCOSA OF SHEEP INTESTINE

• ESSENTIALLY MONOFILAMENTESSENTIALLY MONOFILAMENT• PROCESSED BY TRU GAUGING WHICH PROCESSED BY TRU GAUGING WHICH

ENSURES UNIFORM DIAMETER AND ENSURES UNIFORM DIAMETER AND TRU CHROMICISING WHICH ADDS TRU CHROMICISING WHICH ADDS STRENGTHSTRENGTH

• AVAILABLE AS PLAIN AND CHROMIC AVAILABLE AS PLAIN AND CHROMIC CATGUTCATGUT

PLAIN CATGUTPLAIN CATGUT

• TENSILE STRENGTH 7-10 DAYSTENSILE STRENGTH 7-10 DAYS

• ABSORPTION -70 DAYSABSORPTION -70 DAYS

• CAUSES MORE TISSUE REACTIONCAUSES MORE TISSUE REACTION

• USES- TO LIGATE SUPERFICIAL USES- TO LIGATE SUPERFICIAL BLOOD VESSELS,SUBCUTANEOUS BLOOD VESSELS,SUBCUTANEOUS TISSUE,LIP AND ORAL MUCOSATISSUE,LIP AND ORAL MUCOSA

CHROMIC CATGUTCHROMIC CATGUT

• CHROMICISING ALTERS THE SHADE TO CHROMICISING ALTERS THE SHADE TO BROWN BROWN

• RESISTS DIGESTIVE ENZYMES AND RESISTS DIGESTIVE ENZYMES AND PROLONGS ABSORPTIONPROLONGS ABSORPTION

• LESS TISSUE REACTIONLESS TISSUE REACTION• TENSILE STRENGTH LASTS 10-14 DAYSTENSILE STRENGTH LASTS 10-14 DAYS• ABSORPTION IN 90-110 DAYSABSORPTION IN 90-110 DAYS• USED IN ALL GYNECOLOGICAL USED IN ALL GYNECOLOGICAL

PROCEDURES,SUTURING PROCEDURES,SUTURING PERITONEUM,MUSCLES AND FASCIAPERITONEUM,MUSCLES AND FASCIA

• STORED IN A FLUID THAT KEEPS IT STORED IN A FLUID THAT KEEPS IT SUPPLE AND HYDRATEDSUPPLE AND HYDRATED

• STERILISED BY GAMMA IRRADIATION STERILISED BY GAMMA IRRADIATION WITH 2.5 MEGA RADSWITH 2.5 MEGA RADS

• REACTION TO IMPURITIES OR REACTION TO IMPURITIES OR MUCOPOLYSACCHARIDES RAREMUCOPOLYSACCHARIDES RARE

CATGUT ABSORPTIONCATGUT ABSORPTION

PLAIN CHROMIC

WOUND SUPPORT

7 – 10 days 10-14 days

MASS ABSORPTION

60 – 90 days

90 – 110 days

SYNTHETIC SYNTHETIC ABSORBABLEABSORBABLE

SYNTHETIC ABSORBABLESYNTHETIC ABSORBABLE

• POLYGLACTIN 910(VICRYL)POLYGLACTIN 910(VICRYL)

• COATED POLYGLACTIN370COATED POLYGLACTIN370

• GAMMA IRRADIATED COATED GAMMA IRRADIATED COATED POLYGLACTIN (VICRYL RAPIDE)POLYGLACTIN (VICRYL RAPIDE)

• POLYGLICAPRONE 25(MONOCRYL)POLYGLICAPRONE 25(MONOCRYL)

• CAPROFYLCAPROFYL

• PDS AND PDS IIPDS AND PDS II

SYNTHETIC ABSORBABLESSYNTHETIC ABSORBABLES

• PREPARED FROM CARBOHYDRATESPREPARED FROM CARBOHYDRATES• TWICE AS STRONG AS NATURAL TWICE AS STRONG AS NATURAL

ABSORBABLESABSORBABLES• AVAILABLE AS MONOFILAMENT AND BRAIDEDAVAILABLE AS MONOFILAMENT AND BRAIDED• DEPENDABLE ABSORPTION RATEDEPENDABLE ABSORPTION RATE• FULLY ABSORPED AND LEAVE BEHIND NO FULLY ABSORPED AND LEAVE BEHIND NO

FOREIGN BODYFOREIGN BODY• ABSORPTION BY HYDROLYSISABSORPTION BY HYDROLYSIS• EXCELLENT HANDLINGEXCELLENT HANDLING• STERILISED BY ETHYLENE OXIDE AND SHELF STERILISED BY ETHYLENE OXIDE AND SHELF

LIFE OF 5 YARSLIFE OF 5 YARS

VICRYLVICRYL

• POLYGLACTIN AND LACTIDE IN 9:1 POLYGLACTIN AND LACTIDE IN 9:1 POLYMER SEQUENCEPOLYMER SEQUENCE

• MAINTAINS 60% STRENGTH AT 2 MAINTAINS 60% STRENGTH AT 2 WEEKS,30% AT 3 WEEKSWEEKS,30% AT 3 WEEKS

• ABSORPTION COMPLETE AT60-90 ABSORPTION COMPLETE AT60-90 DAYSDAYS

COATED VICRYLCOATED VICRYL

• HAS POLYGLACTIN 370 COATING ON HAS POLYGLACTIN 370 COATING ON POLYGLACTIN 910POLYGLACTIN 910

• POLYGLACTIN 370 HAS 50% POLYGLACTIN 370 HAS 50% POLYGLACTIN (65% GLYCOLIDE AND POLYGLACTIN (65% GLYCOLIDE AND 35% LACTIDE)AND 50%CALCIUM 35% LACTIDE)AND 50%CALCIUM STEARATE STEARATE

• COATING REDUCES SURFACE COATING REDUCES SURFACE TENSION AND BEHAVES AS A TENSION AND BEHAVES AS A MONOFILAMENTMONOFILAMENT

Coated VICRYLCoated VICRYL

• STRENGTH RETENTIONSTRENGTH RETENTION

• At 14 days – 75 % Tensile StrengthAt 14 days – 75 % Tensile Strength

remainsremains

• At 21 days - 50 % Tensile StrengthAt 21 days - 50 % Tensile Strength

remainsremains

Coated VICRYLCoated VICRYL

• WOUND SUPPORT : 28 – 35 DAYSWOUND SUPPORT : 28 – 35 DAYS

• MASS ABSORPTION : 56 – 70 DAYSMASS ABSORPTION : 56 – 70 DAYS

VICRYL RAPIDEVICRYL RAPIDE

• COATED POLYGLACTIN 910 EXPOSED TO COATED POLYGLACTIN 910 EXPOSED TO GAMMA IRRADIATION WHICH MAKES IT GAMMA IRRADIATION WHICH MAKES IT LOW MOLECULAR WEIGHT WITH A TENSILE LOW MOLECULAR WEIGHT WITH A TENSILE STRENGTH 30% LESSSTRENGTH 30% LESS

• LOSS OF TENSILE STRENGTH BETWEEN 10-LOSS OF TENSILE STRENGTH BETWEEN 10-12 DAYS12 DAYS

• ABSORPTION COMPLETE in 42 DAYSABSORPTION COMPLETE in 42 DAYS• USED FOR SKIN/MUCOSA,ORAL/VAGINALUSED FOR SKIN/MUCOSA,ORAL/VAGINAL• SKIN GRAFTS,CIRCUMCISIONSKIN GRAFTS,CIRCUMCISION

MONOCRYLMONOCRYL

• 75% GLYCOLIDE AND 25% CAPROLACTONE75% GLYCOLIDE AND 25% CAPROLACTONE• DYED VIOLET OR UNDYEDDYED VIOLET OR UNDYED• HIGHEST STRENGTH AMONG ABSORBABLESHIGHEST STRENGTH AMONG ABSORBABLES• MOST PLIABLE WITH EXCELLENT HANDLING MOST PLIABLE WITH EXCELLENT HANDLING

PROPERTIESPROPERTIES• LOWEST STIFFNESS INDEXLOWEST STIFFNESS INDEX• TENSILE STRENGTH IS 60% AT 1 WEEK AND TENSILE STRENGTH IS 60% AT 1 WEEK AND

0% AT 21 DAYS0% AT 21 DAYS• ABSORPTION COMPLETE 90-120 DAYSABSORPTION COMPLETE 90-120 DAYS

USESUSES

• SUBCUTANEOUS CLOSURESUBCUTANEOUS CLOSURE

• SUBCUTICULAR SKIN CLOSURESUBCUTICULAR SKIN CLOSURE

• UROLOGICAL PROCEDURESUROLOGICAL PROCEDURES

• BOWEL ANASTOMOSISBOWEL ANASTOMOSIS

• PERITONEAL CLOSUREPERITONEAL CLOSURE

PDS AND PDS IIPDS AND PDS II

• POLYDIOXANONE SUTURES FORMED POLYDIOXANONE SUTURES FORMED BY POYMERISING MONOMER-PARA BY POYMERISING MONOMER-PARA DIOXANONE IN PRESENCE OF A DIOXANONE IN PRESENCE OF A CATALYSTCATALYST

• UNIQUE FEATURE OF FLEXIBILITYUNIQUE FEATURE OF FLEXIBILITY• TENSILE STRENGTH 70% AT 2 WEEKS TENSILE STRENGTH 70% AT 2 WEEKS

AND 25% AT 6 WEEKSAND 25% AT 6 WEEKS• ABSORPTION 180-210 DAYSABSORPTION 180-210 DAYS

USESUSES

• WOUND CLOSUREWOUND CLOSURE

• CAESEREAN AND MYOMECTOMYCAESEREAN AND MYOMECTOMY

• ORTHOPEDIC SURGERYORTHOPEDIC SURGERY

• G.I SURGERYG.I SURGERY

• CARDIOVASCULAR SURGERYCARDIOVASCULAR SURGERY

contraindicationcontraindication

• Conjunctival suturingConjunctival suturing

• Cuticular suturesCuticular sutures

• Vaginal epithelial suturesVaginal epithelial sutures

NON ABSORBABLENON ABSORBABLE

• BLACK SILK(MERSILK)BLACK SILK(MERSILK)

• NYLON(ETHILON)NYLON(ETHILON)

• POLYPROPYLENE(PROLENE)POLYPROPYLENE(PROLENE)

• PRONOVAPRONOVA

• ETHIBOND EXCELETHIBOND EXCEL

• MERSILENEMERSILENE

• STAINLESS STEEL(ETHISTEEL)STAINLESS STEEL(ETHISTEEL)

MERSILKMERSILK

• Natural Nonabsorbable – BraidedNatural Nonabsorbable – Braided

• Made from Silkworm CocoonsMade from Silkworm Cocoons

• Twisted Virgin SilkTwisted Virgin Silk

• Braided Wax Coated SilkBraided Wax Coated Silk

Black Braided Silk

In-Vivo Profile

• Tissue Reaction - Moderate

• BSR - Looses T.S - 3 Months

• Absorption - Fragments & absorbs 6-8 months

MERSILKMERSILK

• Very Good Handling Very Good Handling

• Very Good KnottingVery Good Knotting

• Standard for many yearsStandard for many years

ETHILONETHILON

• First Synthetic Monofilament First Synthetic Monofilament

NonabsorbableNonabsorbable

• Replaced Monofilament SilkReplaced Monofilament Silk

• Used mainly in Skin and Abdominal ClosureUsed mainly in Skin and Abdominal Closure

ETHILONETHILON

Drawbacks:Drawbacks:

• Nylon Absorbs WaterNylon Absorbs Water

• Loses Strength at a rate of 15 % per Loses Strength at a rate of 15 % per annumannum

• Suture Sinus and Extrusion in some Suture Sinus and Extrusion in some casescases

NYLONNYLON(ETHILON)(ETHILON)

• Smooth, Easy passage through tissueSmooth, Easy passage through tissue

• No Bacterial harbours or CapillarityNo Bacterial harbours or Capillarity

• Strong, Controlled Elasticity allows Ultra Strong, Controlled Elasticity allows Ultra

Fine GaugesFine Gauges

• Provided Long term Wound SupportProvided Long term Wound Support

• Can be used in many applications including Can be used in many applications including

Opthalmics and MicrosurgeryOpthalmics and Microsurgery

PROLENEPROLENE

• Synthetic Synthetic

• NonabsorbableNonabsorbable

• MonofilamentMonofilament

PROLENEPROLENE

• Monofilament to replace NylonMonofilament to replace Nylon

• Better Control of Stretching Better Control of Stretching

PropertiesProperties

• More Pliable for handling and More Pliable for handling and

knottingknotting

• Smoothest Suture Surface everSmoothest Suture Surface ever

PROLENEPROLENE

• Extends upto 30% before BreakingExtends upto 30% before Breaking

• Indefinite Tensile StrengthIndefinite Tensile Strength

• Excellent Handling Excellent Handling

• Secured KnottingSecured Knotting

• Sterilised by EOSterilised by EO

• Inert and Non-BiodegradableInert and Non-Biodegradable

• Less ThrombogenicLess Thrombogenic

MONOFILAMENT KNOTTINGMONOFILAMENT KNOTTING

Suture preferenceSuture preference

• Skin- braided silk, monocryl,nylon,vicryl Skin- braided silk, monocryl,nylon,vicryl rapiderapide

• Subcutaneous tissue- chromic/plain Subcutaneous tissue- chromic/plain catgut,vicrylcatgut,vicryl

• Fascia,muscle- chromic catgut,vicrylFascia,muscle- chromic catgut,vicryl

• Peritoneum- monocryl,vicryl, prolenePeritoneum- monocryl,vicryl, prolene

• Rectus sheath- proleneRectus sheath- prolene

• Vaginal mucosa- vicryl rapide, catgutVaginal mucosa- vicryl rapide, catgut

• Episotomy suture- vicryl rapideEpisotomy suture- vicryl rapide

THANK THANK YOUYOU

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