Absorbable Sutures
Internal
Intradermal/ subcuticular
Rarely on skin
Non-absorbable Suture
Primarily Skin
Needs to be removed later
Stainless steel = exception
Can be used internally
Ligature
Orthopedics
Can be left in place for long periods
Reading the Suture Label
Company
Monofilament    Vs.   Multifilament
memory                easy to handle
less tissue drag        more tissue drag
doesn’t wick            wicks/ bacteria
poor knot security        good knot security
- tissue reaction        +tissue reaction
Natural Vs. Synthetic
Natural:
Gut
Chromic Gut
Silk
Collagen
All are absorbable
Gut/ Chromic Gut
Made of submucosa of small intestines
Multifilament
Breaks down by phagocytosis: inflammatory reaction common
Gut/ Chromic Gut
Chromic: tanned, lasts longer, less reactive
Easy handling
Plain: 3-5 days
Chromic: 10-15 days
Bacteria love this stuff!
Collagen and Silk
Natural sutures
VERY reactive, absorbable
Ophthalmic surgery only
Vicryl (Polyglactin 910)
Braided, synthetic, absorbable
Stronger than gut: retains strength 3 weeks
Broken down by enzymes, not phagocytosis
Break-down products inhibit bacterial growth
Can use in contaminated wounds, unlike other multifilaments
Dexon and PGA
Polymer of glycolic acids
Braided, synthetic, absorbable
Broken down by enzymes
Both PGA and dexon have increased tissue drag, good knot security
Both are stronger than gut
PDS (polydioxine)
Monofilament (less drag, worse knot security – lots of “memory”)
Synthetic, absorbable
Very good tensile strength (better than gut, vicryl, dexon) which lasts months
Absorbed completely by 182 days
Maxon (polyglyconate)
Monofilament- Memory
Synthetic Absorbable
Very little tissue drag
Poor knot security
Very strong