Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Fundamentals of Surgical Practice
The Surgical Patient
Approach to the surgical patient
The paediatric patient
Surgical Techniques
Tissue Handling
Suture and suture technique
Basic Surgical Procedures
Wound management
Specific lacerations and wounds
Foreign bodies
Cellulitis and abscess
Excision and biopsies
Suture and Suture Technique


Suture is made of a variety of materials with a variety of properties. It may be synthetic or biological, absorbable or non-absorbable and constructed with a single or multiple filaments.

Nylon is an example of a synthetic suture. Biological suture, such as gut, increases physiological response and is not good for use in the skin. Silk is a braided biological suture, which should not be used in dirty wounds. The multiple filaments create space, allowing bacterial trapping, an silk is absorbed slowly.

Choice among these materials depends on:

:: Availability
:: Individual preference in handling
:: Security of knots
:: Behaviour of the material in the presence of infection
:: Cost.

If you want a suture to last, for example when closing the abdominal wall or ligating a major vessel, use one made of non-absorbable material. Use absorbable material in the urinary tract to avoid the encrustation and stone formation associated with non-absorbable suture.

All varieties of suture material may be used in the skin, but a reactive suture such as silk should be removed within a few days. In skin wounds, remove sutures early to reduce visible markings.
Because of the ease of tying, braided suture may be easier to use for interrupted stitches. Absorbable and non-absorbable monofilament suture is convenient for continuous running stitches.

The commercial suture package is marked with the needle shape and size, the suture material and the suture thickness. Suture is graded according to size. The most popular grading system rates the suture material downward from a very heavy 2 to a very fine ophthalmic suture of 10/0. Most common operations can be completed with suture material between sizes 4/0 and 1.

Different materials have different strength characteristics. The strength of all sutures increases with their size.

Suture can be purchased in reels and packaged and sterilized on site as a less expensive alternative to packages from the manufacturer.


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  Kep Points  
Suture is made of a variety of materials with a variety of properties

There are many types of suture and a variety of materials; learn the properties of each, become confident using a few and regularly use those you are most comfortable with

Suturing is the most versatile, least expensive and most widely used technique of securing tissue during an operative procedure.