Chapter Three: Sutures and Suturing Techniques
Suture, a Latin word ‘Sutura’ means ‘seam’, a line formed by sewing together 2 pieces of any
matter. In other words, it is the surgical uniting of 2 surfaces by means of stitches. However, it is
also referred to a material/surgical thread that is used to ligate off the vessels or any hollow
organ or keeping the organs or tissues in place. There is another term ‘Suturing’ which is the
temporary
anatomical reconstruction (reduction, alignment and fixation) of severed ends of soft tissue by
appropriate suture material. Surgical thread that is used to tie off the blood vessels or any hollow
structure is ligature.
Properties of an Ideal Suture
Possess tensile strength corresponding to the wound where it is applied
Easy to handle with good knot security
Non-electrolytic, non-capillary, non-allergenic and non-carcinogenic
Stimulate minimal tissue reaction
Does not predispose to oedematous inflammation
Bio-inert and passes through the tissues without any friction
Inexpensive, easily available and easy to sterilize without alteration
Classification
Sutures are generally classified as absorbable or non-absorbable sutures based on their rate of
degradation and loss of tensile strength. Suture materials that retain tensile strength for longer
than 60 days are classified as non-absorbable while those materials which lose their tensile
strength within that period are classified as absorbable. Further, sutures may also be classified
based on the source (natural or synthetic) or on thickness
Natural Absorbable Suture Materials
Catgut (Surgical Gut/Surgigut)
Catgut is prepared either from the submucosa of sheep small intestine or serosal layer of cattle
small intestine and is essentially composed of formaldehyde treated collagen.
Collagen
Collagen, a multifilament suture material is obtained by processing of bovine flexor tendon with
formaldehyde or chromic salts or both. Its advantages over catgut are its non-septic source and
simplicity in processing.
Kangaroo Tendon
It is obtained from tail of Kangaroo and has very high tensile strength.
Fascia Lata
It is obtained from bovine fascia lata and is used for additional support to the fascial layers.
Synthetic Absorbable Suture Materials
Polyglycolic Acid (Dexon)
Polyglycolic acid (PGA) is a braided multifilament, glycolic acid polymer, which gets absorbed
by hydrolysis (esterases) and not by phagocytosis.
Polyglactin 910 (Vicryl)
It is the braided multifilament, synthetic absorbable suture material and is composed of glycolic
acid and lactic acids in the ratio of 9:1.
Polydiaxanone
It is a monofilament suture material composed of polymer of paradiaxanone and is more flexible
than PGA and polyglactin 910.
Non-absorbable Suture Materials
Silk
It is obtained from the silk worm cocoons and is available as braided multifilament. Capillary
action can be reduced by treating it with oil, wax or silicone.
Cotton
It is readily available and inexpensive multifilament suture material that can be autoclaved.
Nylon
It is available as both monofilament as well as multifilament suture material. It is biologically
inert and produces minimal tissue reaction.
Polypropylene
It is a polymer of propylene and is available as monofilament suture.
Stainless Steel
It is the only metallic suture that is currently being used.
Suture Techniques
Significance of Suture Patterns
Impact on the apposition of tissues
Plays a large role in wound healing
Specific patterns can be used to accurately appose tissues, distribute wound tension,
invert suture lines, and approximate the ends of tendons
There are number of suture patterns that have been described for animal use and have been
categorized into different groups according to the following factors:
Tendency to overcome tension- like tension sutures
Anatomical area of application- like skin sutures, tendon sutures, etc
Fashion in which applied like- interrupted or continuous
Ability to promote apposition, inversion or eversion of the tissue margins