Types of Suture

Types of Sutures 1) Surgical Sutures 2) Suture Types 1. Absorbable Sutures * Polyglycolic Acid Sutures * Polyglactin 910 Sutures * Catgut Sutures * Poliglecaprone Sutures * Polydioxanone Sutures 2. Non-absorbable Sutures * Polypropylene Sutures * Polyamide / Nylon Sutures * Polyester Sutures * Silk Sutures * Polyvinylidene fluoride / PVDF Sutures * Stainless Steel Sutures Absorbable and non absorbable sutures

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Sutures can be divided into two types – those which are absorbable and will break down harmlessly in the body over time without intervention, and those which are non-absorbable and must be manually removed if they are not left indefinitely. The type of suture used varies on the operation, with the major criteria being the demands of the location and environment and depends on the discretion and professional experience of the Surgeons. * Sutures to be placed internally would require re-opening if they were to be removed. Sutures which lie on the exterior of the body can be removed within minutes, and without re-opening the wound.

As a result, absorbable sutures are often used internally; non-absorbable externally. * Sutures to be placed in a stressful environment, for example the heart (constant pressure and movement) or the bladder (adverse chemical presence) may require specialized or stronger materials to perform their role; usually such sutures are either specially treated, or made of special materials, and are often non-absorbable to reduce the risk of degradation. Absorbable sutures include :- Polyglycolic Acid sutures, Polyglactin 910 , Catgut, Poliglecaprone 25 and Polydioxanone sutures. Non-Absorbable sutures include :- Polypropylene utures, Nylon (poylamide), Polyester, PVDF, silk and stainless steel sutures. Monofilament and Multifilament Sutures Sutures can also be divided into two types on the basis of material structure i. e. monofilament sutures and multifilament or braided sutures. Braided sutures provide better knot security whereas monofilament sutures provide better passage through tissues. In general, Monofilament sutures elicit lower tissue reaction compared to braided sutures. Monofilament sutures include :- Polypropylene sutures, Catgut, Nylon, PVDF, Stainless steel, Poliglecaprone and Polydioxanone sutures.

Multifilament or braided sutures include :- PGA sutures, Polyglactin 910, silk and polyester sutures. Synthetic and Natural Sutures Surgical sutures can also be divided into two types on the basis of raw material origin i. e. natural and synthetic sutures. Natural sutures include silk and catgut sutures whereas all other sutures are synthetic in nature. Suture Techniques Running, or Continuous Stitch| The “Running” stitch is made with one continuous length of suture material. Used to close tissue layers which require close approximation, such as the peritoneum. May also be used in skin or blood vessels.

The advantages of the running stitch are speed of execution, and accommodation of edema during the wound healing process. However, there is a greater potential for malapproximation of wound edges than with the interrupted stitch. | | Interrupted Stitch| Each stitch is tied separately. May be used in skin or underlying tissue layers. More exact approximation of wound edges can be achieved with this technique than with the running stitch. | | Mattress Suture| A double stitch that is made parallel (horizontal mattress) or perpendicular (vertical mattress) to the wound edge.

Chief advantage of this technique is strength of closure; each stitch penetrates each side of the wound twice, and is inserted deep into the tissue. | | Purse String| A continuous stitch paralleling the edges of a circular wound. The wound edges are inverted when tied. Commonly used to close circular wounds, such as a hernia or an appendiceal stump. | | Smead-Jones/Far-and-Near| A double loop technique alternating near and far stitches. Commonly used for approximating fascial edges. | | Continuous Locking, or Blanket Stitch| A self-locking running stitch used primarily for approximating skin edges. |

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