Suture materials comparison chart

Numerous different surgical suture materials exist.^[1] The following table compares some of the most common absorbable sutures.

	Plain catgut	Chromic catgut	Polyglycolide (P.G.A.)	Polydioxanone (PDS)
Description	Absorbable biological suture material. Plain is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. The natural plain thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Plain is absorbed by enzymatic degradation.	Absorbable biological suture material. Chromic is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. Due to undergoing a ribbon stage chromicisation (treatment with chromic acid salts), the chromic offers roughly twice the stitch-holding time of plain catgut. The natural chromic thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Chromic is absorbed by enzymatic degradation. Note – catgut is no longer used in the UK for human surgery.	It is a synthetic absorbable suture material. Braided synthetic absorbable multifilament made of polyglycolic acid and coated with N-laurin and L-lysine, which render the thread extremely smooth, soft and knot safe.	It is a synthetic absorbable suture material. Monofilament synthetic absorbable suture, prepared from the polyester, poly (p-dioxanone).
Composition	?	Natural purified collagen	Polyglycolic acid	Polyester and poly (p-dioxanone)
Tensile strength	Strength retention for at least 7 days.	Maintains strength for 10–14 days[2]	84% at 2 weeks, 23% at 4 weeks [2]	80% at 2 weeks, 44% at 8 weeks. Complete absorption within 200 days[2]
Structure	Multifilament	Multifilament	Braided	Monofilament
Origin	Bovine serosa surface finish.	Bovine serosa	Synthetic	Synthetic through the critical wound
Treatment	?	Treatment with a glycerol containing solution and chromic acid salts	Coated with magnesium stearate	Uncoated
Type of absorption	Proteolytic enzymatic digestion complete by 90 days.	Proteolytic enzymatic digestion complete in 70 days. Absorption by enzymatic digestion and starts losing tensile strength on implantation from 18–21 days of catgut chromic	Absorption by hydrolysis complete between 60 and 90 days. Always predictable and reliable	Wound support can remain up to 42 days, however tensile strength decreases to about 70% at 14 days and 25% at 42 days
Tissue reaction	Moderate. Plain catgut enjoys lower tissue reaction as compared to chromicised.	Moderate.	?	?
Thread color	Straw	Brown	Violet and undyed	Violet and clear
Size available	USP 6-0 (1 metric) to USP 5 (100 metric).	USP 6-0 (1 metric) to USP 5 (100 metric).	USP 6-0 (1 metric) to USP 2 (5 metric)	USP 6-0 (1 metric) to USP 2 (5 metric)
Sterilization	Sterilizing fluid containing EO [3]	Sterilizing fluid containing EO [3]	E.O. gas.	E.O. gas
Advantages	Very high knot-pull tensile strength, good knot security due to special excellent handling features	Very high knot-pull tensile strength, good knot security due to special surface finish, improved smoothness due to the dry presentation of the thread, excellent handling features	High initial tensile strength, guaranteed holding power through the critical wound healing period. Smooth passage through tissue, easy handling, excellent knotting ability, secure knot tying	Tensile strength retention, guaranteed holding power
Indications	For all surgical procedures especially when tissues that regenerate faster are involved. General closure, ophthalmic, orthopedics, obstetrics/gynecology and gastro-intestinal tract surgery.	For all surgical procedures, especially for tissues that regenerate faster.	Subcutaneous, intracutaneous closures, abdominal and thoracic surgeries	PDS is particularly useful where the combination of an absorbable suture and extended wound support is desirable, pediatric cardiovascular surgery, ophthalmic surgery
Contraindications	Not recommended for incisions that require the sustaining of the tissues for a prolonged period of time.	Not recommended for an incision that requires sustaining of the tissues for a prolonged period of time.	This suture being absorbable should not be used where extended approximation of tissue is required.	This type of suture being absorbable is not to be used where prolonged approximation of tissues under stress is required and/ or in conjunction with prosthetic devices
Precautions	Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb the sutures at a higher rate. Cardiovascular surgery, due to the continued heart contractions. It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganisms. Avoid using where long term tissue approximation is needed. Absorption is faster in infected tissues	It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganism. Cardiovascular surgery, due to the continued heart contractions. Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb this suture at a higher rate.	Special precautions should be taken in elderly patients and patients with history of anemia and malnutrition conditions. As with any suture material, adequate knot security requires the accepted surgical technique of flat and square ties.	The PDS suture knots must be properly placed to be secure. Conjunctival and vaginal mucosal sutures remaining in place for extended periods may be associated with localized irritation. Subcuticular sutures should be placed as deeply as possible in order to minimize the erythema and induration normally associated with absorption.

References

1. "Examples of Surgical Suture Materials". Tom Robinson. Retrieved 2012-10-21.
2. "Surgical Suture Information". DemeTECH Corporation. Retrieved 2012-04-29.
3. "Catgut Suture Sterilization". Dolphin Sutures. Retrieved 2013-12-21.

3.Types of sutures and suture materials