Surgical Sutures

and Needles

SUTURES

The Ideal Suture

Moynihan 1912
z
z
z
z
z
z
z
z
z

Monofilament
Use for any procedure
Easy to handle
Minimal tissue reaction
High breaking strength
Hold knots securely
Absorbable
Predictable Absorption
Sterile

Classification of Sutures
CHARACTERISTIC

STRUCTURE

MATERIAL

Absorbable

Nonabsorbable

Monofilament

Multifilament

Synthetic

Biological

Advantage
ABSORBABLE
z Broken down by
body
z No foreign body left

NONABSORBABLE
z Permanent Wound
Support

Disadvantage
ABSORBABLE
z Time of wound
support

NONABSORBABLE
z Foreign body left
z Suture sinus
z Suture extrusion

Advantage
MONOFILAMENT
z Smooth surface
z Low friction
Q
Q

Less drag
Less tissue
trauma

No bacterial
harbours
No capilarity

MULTIFILAMENT
z Strength
z Soft & pliable
z Good handling

Disadvantage
MONOFILAMENT
z Handling &
Knotting
z Ends/knot burial
z Strecth

MULTIFILAMENT
z Bacterial
harbours
z Capillary action
z Tissue trauma
Q
Q

Drag
Cutting

Advantage
BIOLOGICAL
z Handling &
Knotting
z Economical

SYNTHETICS
z Resemble
natural
substances
z Absorption by
hydrolysis
z Predictable
absorption
z Strong

Disadvantage
BIOLOGICAL
z Absorption by
enzymatic
action
z Tissue reaction
z Unpredictable
absorption

SYNTHETICS
z Monofilament
handling

Plain/F.A. Gut

Biological

Chromic Gut
VICRYL*Rapide

Absorbable
Synthetic

VICRYL*
MONOCRYL*
PDS II*
PANACRYL*

* Trademark

Absorption Terminology
ABSORBABLE SUTURES
LOSS OF
TENSILE STRENGTH
z
z

Wound support
No loss of suture
bulk
Strength reduced

ABSORPTION OF
MASS
Elimination of
Suture
Material removed

Suture Handling

Absorbable Sutures

Catgut
VICRYL*
Rapide
Chromic
Catgut
MONOCRYL*
Coated
VICRYL*
PDS* II

WOUND
SUPPORT

ABSORPTION
OF MASS

7 10

60 90

6 14

by 42

17 21

90 110

14 21

90 120

28 35

56 70

up to 56

by 182

Catgut Absorption

Wound
Support
Mass
absorption

PLAIN

CHROMIC

7-10 days

17 21 days

60 90 days

90 110
days

Absorption affected by many factors

Coated VICRYL*
Absorption
z
z
z

Synthetic Absorbable Hydrolysis

Predictable absorption
Minimal tissue reactions

Coated VICRYL* 2/0 at 14 days

Minimal Tissue Reaction
around suture

Chromic Catgut at 14 days

Extensive tissue reaction with
acute inflammatory response

Biological
Biological
Non Absorbable

Silk

ETHILON*

Synthetic
Synthetic

MERSILENE*
ETHIBOND*
PROLENE*
Stainless Steel

* Trademark

MERSILK*
DRAWBACKS
z
z
z

Tissue reactions
Loss of strength
Ultimately
fragments
Foreign body
implanted long
term

NUROLON*

SILK

Greater reaction to biological material

PROLENE* Polypropylene
MINIMAL TISSUE REACTION

Enlarged photomicrograph
PROLENE* suture
Implanted 6 months

NEEDLES

Needle Selection
z

z
z
z

z
z

Minimal trauma to
tissue
Sharpness
Bend resistance
Corrosion
resistance
Sterility
Size, shape &
design

Use of Needle Holders

Eyed Needles
z

z
z
z

z
z

Double suture
strand
Threading time
Resterilisation
Point
maintenance
Risk of corrosion
Risk of
unthreading

Eyed

French / split eye

Suture Attachment
Channel
z Drilled
z

Anatomy of a Surgical
Needle
EYELESS NEEDLE
Needle
point

Chord length

Swage

Needle
radius
Needle
diameter
Needle length
Needle body

Needle Shapes
Circle

3/
8

Circle

Circle

5/
8

Circle

J Shape
Curved
Compound
Curve
Straight

Needle Size Range

45 needle sizes from 3mm to 110mm
MICROSUTURES

3.75mm 8mm

OPHTHALMIC

5mm 16mm

CARDIOVASCULAR

8mm 40mm

SKIN RANGE

9mm 60mm

G.I. RANGE

13mm 40mm

CLOSURE

30mm 110mm

HAND HELD

55mm 110mm

110mm

3mm

Needle Types
z
z
z

Round Bodied
Cutting
Ophthalmic

Round Bodied Needles

Intestinal
z JB Needle
z VISIBLACK*
z Blunt
z ETHIGUARD*
z CC
z

Cutting Needles
z

CONVENTIONAL
CUTTING
Q

Apex of edges on
inside curvature

Cutting Needles
z

REVERSE
CUTTING
Q

Apex of edges on
outside curvature

PACKAGING

Packaging Foil Pack

USP
USP Gauge
Gauge

Metric
Metric
Gauge
Gauge

Code
Code number
number
Denotes
Denotes Easy
Easy
Access
Access packaging
packaging

Manufacture
Manufacture
&
& Expiry
Expiry date
date

Product
Product description
description
&
& colour
colour
Needle
Needle
description
description

Sterilisation
Sterilisation Method
Method
Length
Length

IDENTIFICATION
IDENTIFICATION OF
OF MARKINGS
MARKINGS

Packaging Foil Pack

(Easy Access)
z

Tear in direction
of arrow
Foil & card
open together
revealing
needle
Arm needle
holder
Withdraw
suture

Packaging RELAY*
z

z
z

Single
overwrap
Remove tray
Pull down flap
to expose
Arm needle
holder
Withdraw
suture
KINK FREE SUTURE DISPENSED