SUTURES

Types of Sutures according to the materials

with associated colors
Vicryl suture has a purple color
Nylon suture is green in color
Silk suture is blue
Chromic suture is brown
SUTURES
Plain catgut suture: This is a natural and absorbable form of suture made from
submucosa of healthy sheep and serosa of healthy cattle. It is microfilament (single
thread) and may be plain or coated with chromic. It contains collagen and causes
inflammation which leads to release of protealytic enzymes that digests it in about 5-
6 days.
Chromic catgut suture: A natural absorbable suture with chromic acid added to plain
catgut to make it more inert and decreases the chance of having allergic reactions. It
poisons the neutrophils and decreases infections and it lasts longer for about 21days.
Used in subcorticular closure, for viscera and smell vessels ligation to arrest
hemorrhage and for inner layer of bowel anastomosis. Chromic has good handling
property, good memory, capillary and low degree of ignition of inflammation (it is
inert).
Reconstituted collagen suture: This is a natural absorbable suture made from serosa of
healthy sheep and long tendon of healthy cattle. It is a good suture of the eye in
ophthalmology. Other features are similar to catgut but mode of absorption is based on
type of manufacturer.
Vicryl suture: It is a synthetic absorbable suture that is multifilament, braided (rough) and
coated with dye for identification. The benefits include good handling, poor memory,
decreased capillary and decreased inflammation. It is absorbed by hydrolysis. It can be
mounted on a round body or traumatic needle. Vicryl suture is commonly used in ligation of
vessels, skin closure, subcutaneous closure, anastomosis of bowel. It is absorbed in 3
months.
Monocryl: A synthetic absorbable suture that is monofilament made from Vicryl and it is also
known as Polyglycoprone. It has all characteristics of vicryl but it is absorbed faster than
vicryl and handling is not as good as vicryl. Its memory is intermediate, no capillary action,
inflammation is decreased more than vicryl and is absorbed by hydrolysis.
Silk Suture: This is made from the raw silk from the cocoon of the silk worm. It is natural,
non-absorbable multifilament, braided, usually coated with wax, not degraded by proteolysis
and undergoes fragmentation. It is dyed with black color. Character includes good handling,
poor memory, high capillary (can carry fluid) that is why it is coated with wax, poor
inflammation but because of its high capillary, infection can move from place to place, when
wet and it gets weaker. Used in outer layer of bowel anastomosis, ligation of very large
vessels, used to close skin, ligation of stump in appendectomy.
Cotton Suture: A natural suture made from cotton buds. It is non-absorbable and used the
same way as silk but not braided; it gets stronger when wet.
Prolene suture: It is a synthetic non-absorbable, polypropylene monofilament suture.
Characters include intermediate handling and memory, no capillary effect and inflammation,
and anti-thrombogenic (does not form thrombus). Used mainly for vascular anastomosis,
other uses include subcutaneous closure, closure of fascia such as midline closure. It
undergoes fragmentation.
Polyester sutures: Synthetic non absorbable sutures
Polyamine (Nylon): It is a synthetic non-absorbable suture that may be monofilaments or
polyfilaments and are black. Characters include poor handling, good memory, none capillary
and does not cause inflammation. Used in skin closure, posterior wall repair, apposing fascia,
tendon, hernioplasty and subcutaneous skin closure
Dexon suture (polyglycolic acid): A synthetic delayed absorbable, that is multifilament,
braided, not coated and absorbed in 4 months. Characters include good healing, poor
memory, poor capillary, non-inflammation and absorbed by hydrolysis. Used in any surgery
within the body and skin.
Polydioxanone (PDS): A synthetic smooth suture that is delayed absorbable, monofilament
and lasts longer than dexon. It is absorbed in 6 months; other properties are the same as
dexon.
Time frame taken for absorption or Removal
of Sutures after Surgery
Non absorbable sutures take about 7-10 days
Sutures used on the Head and neck can be removed after 3-5 days
Chest wall and upper limb takes 5-7 days
Abdomen takes 7-10 days
Lower limb takes 10-14 days.
Complications of suture absorption
Hemorrhage (reactional or secondary hemorrhage)
Leakage especially in esophageal and colonic anastomosis
Diverticular formation