Suture materials comparison chart

Last updated May 23, 2023

Numerous different surgical suture materials exist.^[1] The following table compares some of the most common adsorbable sutures.

	Plain catgut	Chromic catgut	Polyglycolide (P.G.A.)	Polydioxanone (PDS)
Description	Adsorbable biological suture material. Plain is an adsorbable suture made by twisting together strands of purified collagen taken from bovine intestines. The natural plain thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Plain is absorbed by enzymatic degradation.	Adsorbable biological suture material. Chromic is an adsorbable suture made by twisting together strands of purified collagen taken from bovine intestines. Due to undergoing a ribbon stage chromicisation (treatment with chromic acid salts), the chromic offers roughly twice the stitch-holding time of plain catgut. Chromic is absorbed by enzymatic degradation. Note – catgut is no longer used in the UK for human surgery.^{[ citation needed ]}	A synthetic adsorbable suture material. Braided synthetic adsorbable multifilament made of polyglycolic acid and coated with N-laurin and L-lysine, which render the thread extremely smooth, soft and knot safe.	A synthetic adsorbable suture material. Monofilament synthetic absorbable suture, prepared from the polyester, poly (p-dioxanone).
Composition	Natural purified collagen	Natural purified collagen	Polyglycolic acid	Polyester and poly (p-dioxanone)
Adsorption rate and tensile strength	Strength retention for at least 7 days.	Maintains strength for 10–14 days^[2]	84% at 2 weeks, 23% at 4 weeks ^[2]	80% at 2 weeks, 44% at 8 weeks. Complete absorption within 200 days^[2]
Structure	Multifilament	Multifilament	Braided	Monofilament
Origin	Bovine serosa surface finish. Made by twisting together strands of purified collagen taken from the small intestine of healthy ruminants	Bovine serosa. The natural chromic thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution	Synthetic	Synthetic
Treatment	Treated with a glycerol-containing solution	Treatment with a glycerol containing solution and chromic acid salts	Coated with magnesium stearate	Uncoated
Type of adsorption	Proteolytic enzymatic digestion complete by 90 days.	Proteolytic enzymatic digestion complete in 70 days. Adsorption by enzymatic digestion and starts losing tensile strength on implantation from 18–21 days of catgut chromic	Adsorption by hydrolysis complete between 60 and 90 days. Always predictable and reliable	Wound support can remain up to 42 days, however tensile strength decreases to about 70% at 14 days and 25% at 42 days
Tissue reaction	Moderate. Plain catgut enjoys lower tissue reaction as compared to chromicised.	Moderate.	?	?
Thread color	Straw	Brown	Violet and undyed	Violet and clear
Size available	USP 6-0 (1 metric) to USP 5 (100 metric).	USP 6-0 (1 metric) to USP 5 (100 metric).	USP 6-0 (1 metric) to USP 2 (5 metric)	USP 6-0 (1 metric) to USP 2 (5 metric)
Sterilization	Sterilizing fluid containing EO ^[3]	Sterilizing fluid containing EO ^[3]	E.O. gas.	E.O. gas
Advantages	Very high knot-pull tensile strength, good knot security due to special surface finish, excellent handling features	Very high knot-pull tensile strength, good knot security due to special surface finish, improved smoothness due to the dry presentation of the thread, excellent handling features	High initial tensile strength, guaranteed holding power through the critical wound healing period. Smooth passage through tissue, easy handling, excellent knotting ability, secure knot tying	Tensile strength retention, guaranteed holding power
Indications	For all surgical procedures especially when tissues that regenerate faster are involved. General closure, ophthalmic, orthopedics, obstetrics/gynecology and gastro-intestinal tract surgery.	For all surgical procedures, especially for tissues that regenerate faster.	Subcutaneous, intracutaneous closures, abdominal and thoracic surgeries	PDS is particularly useful where the combination of an adsorbable suture and extended wound support is desirable, pediatric cardiovascular surgery, ophthalmic surgery
Contraindications	Not recommended for incisions that require the sustaining of the tissues for a prolonged period of time.	Not recommended for an incision that requires sustaining of the tissues for a prolonged period of time.	This suture being adsorbable should not be used where extended approximation of tissue is required.	This type of suture being adsorbable is not to be used where prolonged approximation of tissues under stress is required and/ or in conjunction with prosthetic devices
Precautions	Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb the sutures at a higher rate. Cardiovascular surgery, due to the continued heart contractions. It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganisms. Avoid using where long term tissue approximation is needed. Absorption is faster in infected tissues	It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganism. Cardiovascular surgery, due to the continued heart contractions. Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb this suture at a higher rate.	Special precautions should be taken in elderly patients and patients with history of anemia and malnutrition conditions. As with any suture material, adequate knot security requires the accepted surgical technique of flat and square ties.	The PDS suture knots must be properly placed to be secure. Conjunctival and vaginal mucosal sutures remaining in place for extended periods may be associated with localized irritation. Subcuticular sutures should be placed as deeply as possible in order to minimize the erythema and induration normally associated with adsorption.

Related Research Articles

<span class="mw-page-title-main">Ligature (medicine)</span> Piece of thread (suture) tied around an anatomical structure

In surgery or medical procedure, a ligature consists of a piece of thread (suture) tied around an anatomical structure, usually a blood vessel, another hollow structure or an accessory skin tag to shut it off.

Forceps are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term "forceps" is used almost exclusively in the fields of biology and medicine. Outside biology and medicine, people usually refer to forceps as tweezers, tongs, pliers, clips or clamps.

<span class="mw-page-title-main">Catgut</span> Type of cord made from refined natural fibers of animal intestines

Catgut is a type of cord that is prepared from the natural fiber found in the walls of animal intestines. Catgut makers usually use sheep or goat intestines, but occasionally use the intestines of cattle, hogs, horses, mules, or donkeys. Despite the name, catgut is not made from cat intestines.

Ileostomy is a stoma constructed by bringing the end or loop of small intestine out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an external ostomy system which is placed next to the opening. Ileostomies are usually sited above the groin on the right hand side of the abdomen.

A surgical instrument is a tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in all sorts of surgeries, while others are designed for only certain specialties or specific procedures.

<span class="mw-page-title-main">Craniosynostosis</span> Premature fusion of bones in the skull

Craniosynostosis is a condition in which one or more of the fibrous sutures in a young infant's skull prematurely fuses by turning into bone (ossification), thereby changing the growth pattern of the skull. Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures. Sometimes the resulting growth pattern provides the necessary space for the growing brain, but results in an abnormal head shape and abnormal facial features. In cases in which the compensation does not effectively provide enough space for the growing brain, craniosynostosis results in increased intracranial pressure leading possibly to visual impairment, sleeping impairment, eating difficulties, or an impairment of mental development combined with a significant reduction in IQ.

Asepsis is the state of being free from disease-causing micro-organisms. There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is derived from the older antiseptic techniques, a shift initiated by different individuals in the 19th century who introduced practices such as the sterilizing of surgical tools and the wearing of surgical gloves during operations. The goal of asepsis is to eliminate infection, not to achieve sterility. Ideally, a surgical field is sterile, meaning it is free of all biological contaminants, not just those that can cause disease, putrefaction, or fermentation. Even in an aseptic state, a condition of sterile inflammation may develop. The term often refers to those practices used to promote or induce asepsis in an operative field of surgery or medicine to prevent infection.

Davis & Geck was a surgical/medical device company founded in 1909 by Charles T. Davis and Fred A. Geck originally located in Brooklyn, NY.

A barbed suture is a type of knotless surgical suture that has barbs on its surface. While suturing tissue, these barbs penetrate inside the tissue and lock them into place, eliminating the need for knots to tie the suture. Conventional sutures rely on a surgeon's ability to tie secure knots; barbed sutures provide a knotless alternative in some surgical situations. Barbed sutures are primarily used in cosmetic surgery.

Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds or connect or remove parts of the bowels or lungs. The use of staples over sutures reduces the local inflammatory response, width of the wound, and time it takes to close.

A surgical suture, also known as a stitch or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of thread. There are numerous types of suture which differ by needle shape and size as well as thread material and characteristics. Selection of surgical suture should be determined by the characteristics and location of the wound or the specific body tissues being approximated.

Gastropexy is a surgical operation in which the stomach is sutured to the abdominal wall or the diaphragm. Gastropexys in which the stomach is sutured to the diaphragm are sometimes performed as a treatment of GERD to prevent the stomach from moving up into the chest.

Wound dehiscence is a surgical complication in which a wound ruptures along a surgical incision. Risk factors include age, collagen disorder such as Ehlers–Danlos syndrome, diabetes, obesity, poor knotting or grabbing of stitches, and trauma to the wound after surgery.

Wound closure strips are porous surgical tape strips which can be used to close small wounds. They are applied across the laceration in a manner which pulls the skin on either side of the wound together. Wound closure strips may be used instead of sutures (stitches) in some injuries, because they lessen scarring and are easier to care for.

In medicine, the term cheesewiring or cheesewire effect describes any process in which cells or intercellular matrix are dissected or extruded either by the material being pressed through a taut element, or by the tension of a taut element pulling through tissue. The procedure is typically conducted in a surgical setting.

Catgut suture is a type of surgical suture that is naturally degraded by the body's own proteolytic enzymes. Absorption is complete by 90 days, and full tensile strength remains for at least 7 days. This eventual disintegration makes it good for use in rapidly healing tissues and in internal structures that cannot be re-accessed for suture removal.

<span class="mw-page-title-main">B-Lynch suture</span>

The B-Lynch suture or B-Lynch procedure is a form of compression suture used in obstetrics. It is used to mechanically compress an atonic uterus in the face of severe postpartum hemorrhage. It was developed by Christopher B-Lynch, a consultant obstetrician and gynaecological surgeon based at Milton Keynes General Hospital, Milton Keynes, Buckinghamshire, England. B-Lynch was born in 1947 in Sierra Leone with the birth name of Christopher Balogun-Lynch.

Surgical scissors are scissors specially manufactured as surgical instruments, typically used for cutting sutures, dressings, and cutting and dissecting biological tissue. Surgical scissors are usually made of surgical steel. Some have tungsten carbide reinforcements along their cutting edges, the hardness of which allows manufacturers to create sharper and more durable edges.

Mayo scissors are a type of surgical scissor, often used in the cutting of fascia.

Surgical knots (ligatures) are the knots used to bind suture materials together while binding tissue in surgery. They are used in medical and veterinary settings.

References

↑ "Examples of Surgical Suture Materials". Tom Robinson. Retrieved 2012-10-21.
1 2 3 "Surgical Suture Information". DemeTECH Corporation. Retrieved 2012-04-29.
1 2 "Catgut Suture Sterilization". Dolphin Sutures. Retrieved 2013-12-21.

3.Types of sutures and suture materials

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[Diff_Materials-1] "Examples of Surgical Suture Materials". Tom Robinson. Retrieved 2012-10-21.

[DemeTECH-2] 1 2 3 "Surgical Suture Information". DemeTECH Corporation. Retrieved 2012-04-29.

[DolphinSutures-3] 1 2 "Catgut Suture Sterilization". Dolphin Sutures. Retrieved 2013-12-21.

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