Surgical Technology: Suture Properties

Suture Properties

US Pharmacopeia Sizes

  • Larger “-0” number is smaller/more delicate
    • 2-0 = ’00’, etc.
  • 12-0: 0.001-0.009 mm
  • 11-0: 0.010-0.019 mm
  • 10-0: 0.020-0.029 mm
  • 9-0: 0.030-0.039 mm
  • 8-0: 0.040-0.049 mm
  • 7-0: 0.050-0.069 mm
  • 6-0: 0.070-0.099 mm
  • 5-0: 0.1-0.149 mm
  • 4-0: 0.15-0.19 mm
  • 3-0: 0.2-0.249 mm
  • 2-0: 0.30-0.339 mm
  • 1-0: None
  • 0: 0.35-0.399 mm
  • 1: 0.4-0.49 mm
  • 2: 0.5-0.59 mm
  • 3 & 4: 0.6-0.69 mm
  • 5: 0.7-0.79 mm
  • 6: 0.8-0.89 mm
  • 7: 0.9-0.99 mm
  • 8: 1.0-1.099 mm
  • 9: 1.1-1.19 mm
  • 10: 1.2-1.29 mm

General Size Use

  • ≥ 2-0: High Tension (Fascia)
  • 3-0: Requiring Good Retention (Scalp, Torso, Hands)
  • 4-0: Requiring Minimal Retention
    • Most Common Size for Superficial Wounds
  • ≤ 5-0: Delicate Areas Needing Little/No Retention (Cosmetic)
    • Also Used in Vascular Cases

Braiding

  • Monofilament (Single Strand)
    • Less Reactive
    • Less Tensile Strength
    • Require More Ties (5-6) to Assure Knot Integrity
    • Lower Risk of Infection
  • Braided (Multiple Strands)
    • Incites a Greater Inflammatory Response
    • Increased Tensile Strength & Pliability
    • Require Fewer Ties (3-4) to Assure Knot Integrity
    • More Likely to Harbor Infection

Monofilament (Above) & Braided (Below)

Absorption

  • Absorbable
    • More Reactive – More Scarring
    • Absorption Time Depends on Material
  • Non-Absorbable
    • Less Reactive – Less Scarring
    • Time to Removal Depends on Location/Function

Barbed Suture

  • Suture with Barbs Along the Length
    • Barbs Made by Cutting into the Shaft of Smooth Suture
    • Barbs Prevent Suture from Retracting Backwards
    • Fixed at the End with Either a Loop or Anchor
  • Brands:
    • Quill
    • V-Loc
    • Stratafix Spiral
  • Effects of Barbed Suture:
    • No Knots Required
    • Some Studies Show that Barbed Suture Better Maintains Tissue Tension & Integrity Over the Entire Closure (Debated)
      • Distributes Force Over a Larger Contact Area & Reduces Tension on Tissue
      • Despite a Reduced Tensile Strength (Due to Cutting into the Suture)
    • Improved Efficiency – Reduced Closure Times & Easier Closure in a Laparoscopic Setting
    • Effects on Inflammation & Wound Healing Not Yet Proven
  • Negative Effects of Surgical Knots:
    • Reduced Tensile Strength (Stretching & Thinning)
    • Higher Volume & Density of Foreign Body Material – Increasing Inflammatory Reaction

Barbed Suture

Suture Material

Absorbable – Monofilament

  • Chromic Catgut
    • Material: Natural – Sheep/Cattle Mucosa (Not Cats)
    • Absorption: 90 Days
      • Strength Maintains for 1-2 Weeks
  • Monocryl
    • Material: Synthetic – Poliglecaprone
    • Absorption: 90-120 Days
      • 50% at 1 Week, 25% at 2 Weeks
  • PDS
    • Material: Synthetic – Polydioxanone
    • Absorption: 180-210 Days
      • 80% at 2 Weeks; 44% at 8 Weeks

Absorbable – Braided

  • Vicryl
    • Material: Synthetic – Polyglactin 910
    • Absorption: 56-70 Days
      • 75% at 2 Weeks, 50% at 3 Weeks, 25% at 4 Weeks

Non-Absorbable – Monofilament

  • Prolene
    • Material: Synthetic – Polypropylene
  • Nylon
    • Material: Synthetic – Nylon

Non-Absorbable – Braided

  • Silk
    • Material: Natural – Silk
  • Ethibond
    • Material: Synthetic – Polyester/Dacron

Suture Materials

Needles

Shape

  • Straight
  • 1/4 Circle
  • 3/8 Circle
  • 1/2 Circle
  • 5/8 Circle

Point

  • Tapered
    • Round Body Tapered to a Point
    • Separates Tissue Rather Than Cut
    • Provides Smallest Diameter Hole
    • Good for Soft Tissue Such as Bowel or Subcutaneous Tissue
  • Cutting
    • Triangular Body with a Cutting Edge on Inside
    • Allows Smooth & Atraumatic Penetration
    • Wound & Laceration Repair
    • “Reverse Cutting” – Edge on Outside

Basic Needles

  • Tapered
    • Straight:
      • ST (Straight Taper)
    • 3/8 Circle:
      • BV (Blood Vessel)
      • C (Cardiovascular)
      • TE (Three-Eighths)
    • 1/2 Circle:
      • SH (Small Half)
      • MH (Medium Half)
      • LH (Large Half)
      • MO (Mayo)
      • TP (Taper Point)
      • CT (Circle Taper)
    • 5/8 Circle:
      • MF (Modified Ferguson)
      • UR (Urology)
  • Cutting
    • Straight:
      • SC (Straight Cutting)
    • 3/8 Circle:
      • CC (Calcified Coronary)
      • PC (Precision Cosmetic)
      • PS (Plastic Surgery)
    • 1/2 Circle:
      • V (Tapercut)
  • Reverse Cutting
    • 3/8 Circle:
      • P (Plastic)
      • FS (For Skin)
      • FSL (For Skin Large)
      • FSLX (For Skin Extra Large)

Needle Shpaes

Needle Points