Sutures

Sutures

Sutures are one of the most important medical devices that is used in
surgery. In cardiovascular procedures the sutures can be used to
suture tissue with tissue, or tissue with an implantable device. These
are available in various sizes (suture diameter) and polymers
(absorbable and non-absorbable). Further the sutures vary in forms,
they can be either braided, monofilament or knotless sutures.

History
1650 BC 2000s AD
The origins of surgery can be traced
back many centuries. Through the ages,
practitioners have used a wide range of
materials and techniques for closing
tissue..

Ants

In the tenth century BC, the ant was held

over the wound until it seized the wound
edges in its jaws. It was then decapitated
and the ant's death grip kept the wound
closed.

Thorns

The thorn, used by African tribes to close

tissue, was passed through the skin on
either side of the wound. A strip of
vegetable fibre was then wound around
the edge in a figure eight.

Sterilised Catgut

The tough membrane of sheep intestine

was provided to the surgeon pre-sterilised
and required threading through the eye of
the needle before use.

Swaged on Needles

Post World War II brought the swaged-on

needle. The thread fits into the hollow end
of the needle, allowing it to pass through
tissue without the double loop of thread
that exists with a conventional needle,
reducing tissue trauma.

Suture Classification
Natural or Synthetic (man made)
Monofilament or Multifilament (braided)
Absorbable or Non-Absorbable

The Ideal Suture

Minimal tissue reaction

Smoothness - minimum tissue drag
Low Capillarity
Max tensile strength
Ease of handling - Minimum memory
Knot security
Consistency of performance
Predictable performance
Cost effectiveness

Suture Classification
Monofilament

Multifilament (braided)

Braided v Monofilament
Braided

Monofilament

Has capillary action

Increased infection
risk
Less smooth passage
Less tensile strength
Better handling
Better knot security

No capillary action
Less infection risk
Smooth tissue
passage
Higher tensile
strength
Has memory
More throws required

Absorbable Sutures
These are absorbed within the living tissue
Two main characteristics are:
Tensile strength retention
Absorption rate

Characteristics of Non-Absorbable
Sutures

Permanent
Only used when long term support is required
Removed when used for skin (e.g. in A+E)
Tissue reaction generally low (except silk)
However silk, linen and even nylon will lose tensile
strength over a period of time
True non-absorbable sutures include polyester,
polyethylene, polybutester, polypropylene and steel