Historical Background – Sutures 
      •  Sutures                             •  Stainless wire and 
          – Use of textiles goes back           polymers (nylon, polyester, 
             at least 4000 years                polypropylene) during and 
          – Linen (earliest)                    after WW II
          – Other                            •  1970s Dexron® (polyglycolic 
              • Fe wire, Au, Ag, dried gut,     acid) and Vicryl® (polyglactic 
                horse hair, strips of hide,     acid) resorbable
                bark fibers, silk, and 
                tendon                       •  Controlled degradation
          – Up until 1930, catgut and 
             silk
                                             
            The “Ideal” Suture Material
      •  Universal applicability – only difference in diameter
      •  Limp – easy to handle, no kinks, coiling, twisting, or 
         levitating
      •  Biocompatible
      •  Inert
      •  Strong
      •  Frictionless surface to glide through tissue
      •  High friction for secure knotting
      •  Sterlizable without composition changes
      •  Complete absorption, no residue, after healing is 
         complete – no matter how long it takes
                                             
                    Suture Classification
        Physical/Mechanical        Handling      Biocompatibility   Biodegradation
      Size (diameter)          Pliability        Inflammatory     Tensile breaking 
      Number of Filaments      Packaging           reaction         strength and mass 
      Tensile strength and       memory          Propensity toward  loss
        elongation             Knot tie-down       wound          Biocompatibility of 
      Elastic modulus          Knot slippage       infection,       degradation 
                                                   thrombi          properties
      Bending stiffness        Tissue drag         formation, 
      Stress relaxation and creep                  carcinogenicity, 
      Capillarity                                  and allergy
      Swelling
      Coefficient of friction
                                               
                       Absorbability
     • Lose 50% of breaking strength within 60 days of 
       implanting
     • Monofilament, braided, or twisted
     • Natural or synthetic
        – Natural – enzymatic attack
        – Synthetic – hydrolysis
           • More stable mechanism
     • Rapidity commonly rated as percentage of 
       breaking strength – breaking strength rate (BSR)
        – Can be modified in synthetic sutures
                                     
             BSRs for Some Absorbable Sutures
                                    Natural Fiber             Synthetic Fiber                 BSR
                                                         Poly(glycolide-co-ε-
                                                              caprolactone)  
                                                              (Monocryl)*                                  7 
    Monofilament                                         Poly(p-diaxonone) (PDS 
                                                              II)*                                        35 
                                                         Poly(glycolide co-
                                                              trimethylene                                35 
                                                              carbonate) (Maxon)
                                                              + 
                                                         Polyglactin 910 (Vicryl)*
                                                         Polyglactin 910 (Vicryl                          15 
    Braided                                                   Rapide)*                                     5 
                                                         Polyglycolic acid 
                                                              (Dexon)+                                    12 
                               Plain Surgical Gut                                                          1 
    Twisted                    Light Surgical Gut                                                          4 
                               Medium Surgical Gut                                                         8 
                               Heavy Surgical Gut                                                         11 
               BSR = Approximate days after placement when 50% of breaking strength remains. 
                                          *Ethicon Inc., +Davis & Geck Inc.