by Dr.Indu Ananthoju

1. Presenter:Dr.Indu Ananthoju

2.  Definition
Suture means to sew or seam. In surgery
suture is the act of sewing or bringing
tissue together and holding them in
apposition until healing has taken place.
 A suture is a strand of material used to
ligate blood vessels and to approximate
tissues together.

3. REQUISITES OF AN IDEAL SUTURE
 Tensile strength adequate material strength will
prevent suture breakdown.
 Tissue biocompatibility: sutures made from
organic material will evoke a higher tissue
response than synthetic sutures.
tissue reaction is proportional to amount & size
of suture material.

4.  Low capillarity: multifilament type soak up
tissue fluid by capillary action providing a rich
medium for microbes increasing chances of
inflammation & infection.
 Good handling & knotting properties: ease of
tying & a thread type that permits minimal knot
slippage also influence thread selection.
 Sterilization without deterioration of properties:
dry heat & ethylene oxide gas.

5.  Non allergic, non electrolytic and non
carcinogènic
 Its use should be possible in any operation.
 Low cost
It should not fray, should slide through tissues
readily & knot should not slip after tying.

6.  It should be readily visualized.
 It should not shrink.
 It should not be extruded from the wound.
 On break down ,it should not release toxic
agents.
 It should dissapear without any tissue reaction.

7. classification
Sutures
Origin
Natural
Synthetic
Absorption
Absorbable
Nonabsorbable
Fiber
construction
Multifilament
Monofilament

8. Natural suture materials
natural
absorbable
Plain
catgut
Chromic
catgut
Non-
absorbable
silk linen
Stainless
steel

9. SYNTETIC ABSORBABLE SYNTHETIC NON-ABSORBABLE
POLYGLYCOLIC ACID(DEXON)
POLYGLACTIN(VICRYL)
POLYGLYCONATE(MAXON)
POLYDIAXANONE(PDS)
POLYGLYCAPRONE
BIOSYN(GLYCOMER 361)
CAPROSYN
POLYAMIDE(NYLON)
POLYESTER(DACRON)
POLYPROPYLENE(PROLENE)
POLYBUTESTER

10. Non absorbable sutures are categorized by the
United States Pharmacopeia (USP) as
Class 1 - Silk or synthetic fibers with twisted or braided
construction
Class II - Cotton or linen fibers, coated natural or synthetic
fibers in which the coating does not contribute to T.S
Class III- Metal wire of monofilament or multifilament
construction.

11. ABSORBABLE NON-ABSORBABLE
Loss tensile
strength<60days
retain tensile
strength>60days
enzymatic/hydrolytic
degradation
Reduced/absent
degradation
No foreign body reaction Elicit foreign body reaction
Marked inflammatory
reaction
Inert

12. monofilament multifilament
•Handling difficult
•No wicking
•Smooth and strong
•Thinner
•Easy passage through tissue
•stick well in tissue
•May fracture
•Handling easy
•Wicking is a problem
•Capillarity and infectivity
more
•Thicker
•Knot well

14. • SUTURE PACKAGING
 Sealed in a primary inner packet with inside dry
and outer, see-through peel-back packet –
sterilized
 Sterility maintained until opened or date of expiry
arrived

15. NATURAL ABSORBABLE SUTURES
 Monofilament,derived from highly purified connective
tissue from submucosa of cattle intestine.
 Moderate tissue reaction
 Enzymatic degradation
 Not used in slow healing tissues
 Absorbs rapidly in inflamed tissues
 Ties securely ,holds uniformly

16. plain catgut chromic catgut
Derived from submucosa of
cattle intestine
Tensile strength 7-10 days
Ligate superficial vessels,oral
mucosa,sc
tissue,ophthalmology cases
coated with chromium
Improved handling
Resist degradation in tissues
Decreased tissue reaction
Tensile strength 10-14days
Fascia,peritoneum,large
vessels,mucosa,muscle

17. PLAIN CATGUT:YELLOW
CHROMIC CATGUT
 BROWN IF DYED BLUE

18. Usage of chromic
 4-0 chromic short half circle needle for suturing flaps
in dacryocystorhinostomy
 5-0 chromic double armed for medial spindle
operations

19. Silk
 Braided or twisted
 Multifilament dyed or undyed
 Coated with wax/silicone or uncoated
 Moderate to high tissue reaction
 Tensile strength lost in 1 year
 Risk of infection and tissue reaction
 Acute inflammatory reaction followed by
encapsulation with fibrous tissue

20. Usage of silk
 3-0silk to loop rectus muscles in scleral buckle
surgery
 4-0silk reverse cutting needle for traction suture
 4-0silk taper needle for bridle suture under
extraocular muscles
 8-0silk for scleral closure in open globes

21. Linen
 Twisted(multifilament)
 Moderate tissue reaction
 Remains encapsulated in tissues
Surgical steel wire
 High quality stainless steel
 Mono/multifilament
 Alloy of iron,nickel,chromium
 Remain encapsulated in body tissues

22. SYNTHETIC MATERIAL COMPOSITION
POLYGLYCOLIC ACID(DEXON) 100%GLYCOLIDE
POLYGLACTIN(VICRYL) 90%GLYCOLIDE,10%LACTIDE IN
CALCIUM STEARATE
POLYDIAXONE(PDS) POLYETHYLENE TEREPHTHALATE
POLYGLYCONATE GLYCOLIC ACID
TRIMETHYLENE CARBONATE
POLYGLYCAPRONE GLYCOLATE, LACTONE
BIOSYN GLYCOLIDE,DIAXANONE
TRIMETHYLENE CARBONATE
POLYAMIDE(NYLON) ALIPHATIC POLYMERS
POLYESTER(DACRON) POLYETHYLENE TEREPHTHALATE
POLYPROPYLENE(PROLENE) LINEAR POLYOLEFIN

23. Polyglycolic acid(dexon)
 100%glycolide,braided multifilament
 Dye/undyed,coated/uncoated
 Green
 Mild tissue reaction
 T.S-84% at 2weeks, 23% at 4weeks
 Complete absorption 60-90days
 Hydrolytic degradation

24. Vicryl(polyglactic acid)
 Mixture of lactic and glycolic acid and calcium stearate
 Absorbs in 2-3wks
 Tensile strength75% at 14days,5% at 30 days
 Complete absorption 60-90days
 Mono/multifilament

25. Usage of vicryl
 4-0 vicryl short half circle reverse cutting needle for lateral
tarsal strip procedure
 5-0 vicryl for subcutaneous and orbicularis muscle closure
 6-0 vicryl double armed for tarsal fracture operation and
jones tube anchoring suture
 7-0 vicryl for closure of conjunctiva and skin
 8-0 vicryl taper point needle for conjunctiva closure in
trabeculectomy
 9-0 vicryl suture on a needle for bleb revision and
conjunctival defects

26. Polydiaxone(PDS)
 clear
 Dyed/undyed
 Minimal tissue reaction
 T.S-70% at 2weeks,50% at 4weeks,14% at 8weeks
hydrolytic degradation
 Complete absorption 180days

27. Polyglyconate
 Monofilament
 Dyed/undyed
 Copolymer of glycolic acid& trimethylene carbonate
 Mild tissue reaction
 T.S-70% at 2weeks,8% at 3weeks
 Complete absorption 180days

28. Polyglycaprone(monocryl)
 Monofilament
 Copolymer of glycolate and lactone
 Minimal tissue reaction
 T.S-21days maximum
 Absorption 90-120days

29. Polyamide(nylon)
 Mono/multifilament
 undyed/dyed
 Black/blue
 Minimal tissue reaction
 Tensile strength 15-20%lost per year
 Degradation is none

30. Usage of nylon
 5-0 nylon for skin
 6-0 nylon for skin closure of eyelid and periocular skin
to intubate &tie stent used with pigtail
probe in repair of canalicular lacerations
 9-0 nylon for scleral closure near the limbus
 10-0 nylon for closure of corneal lacerations
penetrating keratoplasty
flap of trabeculectomy

31. Polyester(dacron)
 Uncoated(mersilene), coated(ethibond)
 Ethibond(green/white)
 Braided,composed of polyethylene terephthalate
 Tensile strength>1year
 Extremely strong not weakened by wetting
 Knot holds securely
 Excellent handling
 Mersilene-Minimal tissue reaction
 Ethibond-no tissue reaction
 Used for scleral buckle attachment to the sclera,superior
oblique tuck or posterior fixation suture in strabismus

32. Polypropylene(prolene)
 Composed of synthetic linear polyolefin
 Blue,monofilament
 No tissue reaction
 Tensile strength upto 2years
 Minimal acute inflammatory reaction in tissue
followed by gradual encapsulation
 Resists infection

33. Usage of prolene
 5-0 prolene:blue coloured useful in repair of
lacerations in brow hair
 9-0 prolene:iridodialysis repair with a straight and
large curved needle
 10-0 prolene:iris or scleral fixation suture of
intraocular lens

34. Polybutester
 Greater degree of elasticity
 Tensile strength infinite>1year
 No tissue reaction

35. Absorption time of absorbable
sutures

37. Suture
Types
Knot pull
strength
Knot
security
Handling Tissue
reactivity
In vivo
strength
loss
Catgut Poor Poor (plain)
Fair
(chromic)
Fair High 7-10 days
(plain), 21-
28 days
(chromic)
Silk Fair Good Very good High 1 year
Polypropyle
ne
Fair Poor Poor Low Indefinite
Polyamide Fair Fair Good Low 1.5 – 2.5%
/year
Stainless
steel
High Good Poor Low Indefinite
PGA/PLLA Good Fair -good Good Low 10 days – 4
weeks
Polydioxano
ne
Fair -good Poor-fair Fair-good Low 10 days – 6
weeks

38. Parts of surgical needle

39. SWAGED NEEDLE AND EYED
NEEDLE

40. Swaged Needles
• Sharp Sterile New Needle each time.
• Ready for immediate use.
• Saves time.
• No unthreading.
• Less tissue damage
• The gap is “fully plugged” by the diameter of the
suture strand.
• Chances of “leakage” Less

41. Curvature of needle
1/4circle and 3/8 circle commonly used.
5/8 circle used in DCR

42. ,
BODY SHAPE COMMON USAGE
Straight Flat or shallow depth of skin
wound
Circle 3/8 Shallow depth of skin wound
Circle ½ General purposes, interior of
any wound
Circle 5/8 Deepest, smallest
maneuvering room wounds
such as DCR
Circle 1/4 Same as 1/2 circle,Squint
surgery
J Curve Deep inaccessible wound or
flat wound

43. END OF NEEDLE

44. Needles
Round
bodied
Intestinal
Heavy
blunt
Round/
cutting
Trocar
Point
Taper cut
cutting
Conventi
onal
Reverse
slim
Micro
point
Spatulated
reverse

45. Round body needle
 Seperates rather than cuts
 After passage tissue closes tightly around it
 Leak proof suture line
 Used for soft,easily penetrable tissues

46. Trocar point
 Cutting head merging with round body
 Produces smallest holes of all needles
 Leak proof suture line
Taper cut
 Initial reverse cutting tip with round
body
 Penetrates with minimum resistance
both have leak proof suture line,cut at tip only so
atraumatic
both used in iris repair,tough tissues like fascia,calcific or
sclerotic tissue

47. Conventional cutting needle
 Triangular cross section with apex on inside of needle
curvature upto half length of needle
 Cut at tip and edges of needle
 Suture canal extends superficial to path of needle
tip,may pull out tissue during needle passage
 Used for skin,fascia and aponeurosis

48. Reverse cutting needle
 Triangular in cross section, apex cutting edge on
outside of needle
 Cut at tip and edges of needle
 Suture canal extends deep to the path of needle tip,
accidental perforation may occur
 Occuloplastic surgeries,suturing skin grafts

49. Slim blade needle
 A small conventional cutting needle
 elongated cutting blade
 smooth controlled penetration

50. Micropoint needles(reverse cutting
and spatula needle)
 Thin flat profile
 Cut at tip and sides parrallel to tissue plane
 Needle splits the tissue avoiding accidental perforation
 Used for ophthalmic anterior segment surgeries

51. Cataract
 3/8 circle,spatulated needle nylon

52. Corneal laceration and penetrating
keratoplasty
 10-0 nylon black colour is used

53. Squint
 1/4circle,conventional cutting/spatulated,micropoint
coated vicryl

54. DCR
5/8 circle,taper cut ,5-0 chromic catgut

55. Scleral fixation
 10-0 prolene 16mm straight needle,double armed
needle

56. Scleral buckling/
encirclage: 4-0 ethibond
1/4circle needle spatulated

57. Iris repair
10-0 prolene ,double armed one straight needle second
needle curved micropoint/round bodies 3/8 circle
needle

59. Hold needle at junction of 1/3rd
swaged side and 2/3rd pointed side of
body

60. References
1.Roper Hall MJ.Stallard’s Eye Surgery.7th ed:10-14.
2.Yanoff M,Duker J.Ophthalmology.3rd ed:1492-1493.
3.Krachmer JH,Mannis MJ,Holland EJ.Cornea.2nd
ed(1):1481-1493.
4.Internet.

61. THANK YOU