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2.1 Suture Materials

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Sutures are classified as absorbable or nonabsorbable, and monofilament or multifilament (Table 2.1). Absorbable sutures are desirable in gastrointestinal surgery since they eventually are degraded and removed by the body over days to months. Nonabsorbable sutures do not lose significant strength over 60 days, and remain in the tissues to some degree for years. Monofilament sutures are composed of a single smooth strand, whereas multifilament sutures are braided or woven from multiple strands.

Suture is selected for a specific digestive organ wound repair considering the physical characteristics of the suture material (tensile strength and knot security, absorption rate, surface qualities, capillarity, tissue reactivity), and the environment and healing rate of the tissue involved in the repair. As a rule, more pliable and smaller diameter sutures have favorable handling properties in gastrointestinal surgery compared to larger, stiffer suture materials.

Table 2.1 Characteristics of suture materials used in digestive system procedures.

Absorbable Suture Nonabsorbable Suture Trade Name Type Degradation Process Foreign Body Response Tensile Strength Retention (%) Relative Knot Security Mass Absorption Time (days) Comments
Chromic Catgut Surgical gut; chromic gut Rapid to Intermediate absorbable multifilament Phagocytosis and proteolytic enzymes Moderate Unpredictable Fair Variable; 45–60 d or longer Degradation and tissue reactivity related to where implanted; knots imbibe fluid and unravel if knot ears are cut short
Polyglactin 910 Vicryl Rapide Rapid absorbable multifilament Hydrolysis Mild 50% after 5 d; 0% after 14 d Fair to good 42 Irradiated to aid in dissolving
Vicryl, Coated Vicryl Plus Intermediate absorbable multifilament Hydrolysis Mild 75% after 14 d; 50% after 21 d Fair to good 56–70 Plus designates triclosan (antibacterial) impregnated
Lactomer Polysorb (coated) Intermediate absorbable multifilament Hydrolysis Mild 80% after 14 d; 30% after 21 d Fair to good 56–70 Improvements in braid construction and coating reduce drag and improve knot security
Velosorb (coated) Rapid absorbable multifilament Hydrolysis Mild 60% at 5 d; 0% at 14 d Fair to good 40–50 Irradiated to aid in dissolving; similar to Vicryl Rapide
Polyglycolic Acid Dexon S (uncoated), Dexon II (coated) Intermediate absorbable multifilament Hydrolysis Mild 65% after 14 d; 35% after 21 d Fair to good 60–90 Coated Dexon II helps reduce drag, but decreases knot security
Polyglytone 6211 Caprosyn Rapid to intermediate absorbable monofilament Hydrolysis Minimal 60% after 5 d; 20–30% after 10 d Fair 56 Knots have been known to untie spontaneously when incubated in serum; supple easy to handle for monofilament; fastest mass absorption of absorbable monofilaments
Polygliocaprone 25 Monocryl Rapid to intermediate absorbable monofilament Hydrolysis Minimal 50–60% after 7 d; 20–30% after 14 d; 0% after 21 d Good 91–119 Supple easy to handle for monofilament.
Polyglycolic Acid/Polycaprolactone Quill Monoderm Intermediate absorbable monofilament barbed Hydrolysis Slight 42–76% at 7 d; 36–52% at 14 d N/A 90–120 Uni‐ and bidirectional barbed suture; choose one size larger due to strength loss from barbs. Slightly higher tissue reaction than V‐Loc 90.
Stratafix PGA‐PCL Plus (barbed) Rapid to intermediate absorbable monofilament barbed Hydrolysis Minimal 50–60% after 7 d; 20–30% after 14 d; 0% after 21 d N/A 90–120 Stratafix Monocryl comes with spiral barbs; uni‐ or bidirectional. Plus – antibacterial
Glycomer 631 Biosyn Intermediate absorbable monofilament Hydrolysis Minimal 75% after 14 d; 40% after 21 d Average 110 Knots occasionally untie spontaneously
V‐Loc 90 Intermediate absorbable monofilament barbed Hydrolysis Minimal 90% at 7 d; 75% at 14 d N/A 90 Unidirectional barbed suture; equivalent to strength of suture one size smaller – choose size as you would conventional suture
Polyglyconate Maxon Prolonged absorbable monofilament Hydrolysis Minimal 81% after 14 d; 59% after 28 d; 30% after 42 d Good 180 Similar to PDS II; tends to have slightly more memory in larger sizes
Polydioxanone PDS II; PDS Plus Prolonged absorbable monofilament Hydrolysis Minimal 74% after 14 d; 58% after 28 d; 41% after 42 d Good 180 Plus designates triclosan (antibacterial) impregnated
V‐Loc 180 Prolonged absorbable monofilament barbed Hydrolysis Negligible 80% at 7 d; 75% at 14 d; 65% at 21 d N/A 180 Unidirectional barbed suture; equivalent to strength of suture one size smaller‐choose size as you would conventional suture.
Stratafix PDO, PDO Plus Prolonged absorbable monofilament barbed Hydrolysis Negligible 80% at 7 d; 75% at 14 d; 65% at 21 d N/A 120–180 Stratafix comes in uni‐ and bidirectional strands with symmetrical or spiral barbs. Symmetrical unidirectional barbed sutures are recommended for high tension repairs. PDS plus is antibacterial
Quill PDO Prolonged absorbable monofilament barbed Hydrolysis Negligible 67–80% at 14 d; 50–80% at 28 d N/A 180 Uni‐ and bidirectional barbed suture; choose one size larger due to strength loss from barbs
Polyamide Ethilon; Dermalon; Surgilon Nonabsorbable monofilament N/A Minimal 15–20% loss in 365 d; retains 80% indefinitely Fair N/A Slowly loses strength over years by process of hydrolysis
Nurolon Nonabsorbable multifilament N/A Minimal 15–20% loss in 365 d; retains 80% indefinitely Fair N/A Slowly loses strength over years by process of hydrolysis
Quill Nylon Nonabsorbable monofilament barbed N/A Minimal Similar to conventional nylon N/A N/A Similar to conventional nylon
Polybutester Novafil Nonabsorbable monofilament N/A Negligible N/A Good N/A Handles well for monofilament; stretchy
V‐Loc PBT Nonabsorbable monofilament barbed N/A Negligible N/A N/A N/A Unidirectional barbed suture; permanent soft tissue approximation; equivalent to strength of suture one size smaller – choose size as you would conventional suture
Polypropylene Prolene; Surgipro; Surgipro II Nonabsorbable monofilament N/A Negligible N/A Good N/A Does not lose appreciable strength over long periods of time; one of most inert suture besides steel
Quill Polypropylene Nonabsorbable monofilament barbed N/A Negligible N/A N/A N/A Uni‐ and bidirectional barbed suture; choose one size larger due to strength loss from barbs
Stratafix Polypropylene Nonabsorbable monofilament barbed N/A Negligible N/A N/A N/A Uni‐ or bidirectional spiral barb configuration. Similar characteristics otherwise with conventional polypropylene
Hexafluoropropylene VDF Pronova Nonabsorbable monofilament N/A Negligible N/A Good to very good N/A Good alternative to polypropylene; better handling and strength
Stainless Steel Surgical Stainless Steel (mono); Steel Nonabsorbable monofilament N/A Negligible N/A Excellent N/A Difficult to handle; may tend to cut through soft tissues
Surgical Stainless Steel (Multi); Flexon Nonabsorbable multifilament N/A Negligible N/A Excellent N/A Multifilament improves handling; excellent knot security
Silk Permahand; Sofsilk Nonabsorbable multifilament Proteolytic enzymes Moderate to severe 70% after 14 d; 50% after 30 d Fair Gradual encapsulation by fibrous tissue Considered one of the best handling sutures available
Polyester Mersilene (uncoated); Ethibond Excel (coated); Ticron; Surgidac Nonabsorbable multifilament N/A Mild to moderate N/A Fair Gradual encapsulation by fibrous tissue Strong, relatively good handling; knot security is a concern

NA = Not Applicable.

Chu et al. (1997) and Capperauld (1989).

http://www.medtronic.com/covidien/en‐us/products/wound‐closure.html.

http://woundclosure.ethicon.com/traditional‐suture‐search.

Gastrointestinal Surgical Techniques in Small Animals

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