Information About Sutures in the Operating Room

When asking for a suture generally three peices of information are included; suture size, suture type and suture needle.
For the suture pictured above, a surgeon would say, "Give me a 4-0 Vicryl on a PS-2".
4-0 (pronounced 4-oh) refers to the size of the suture fiber. Vicryl is the type of suture. And finally a PS-2 is the type of needle the suture is attached to.

Suture Size

Smallest

10-0 Typically used in the most delicate surgeries. Common in both Ophthalmic (eye)
9-0 surgery and for repairing small damaged nerves often due to lacerations in the
8-0 hand.

7-0 Used for repairing small vessels and arteries or for delicate facial plastic surgery.
6-0 Common for use in vascular graft sewing such a carotid endarterectomy.

5-0 Used for larger vessel repair such as an Abdominal Aortic Aneurysm or
4-0 skin closure.

3-0 Skin closure when there is a lot of tension on the tissue, closure of muscle layers
2-0 or repair of bowel in general surgery.

0 For closing of the fascia layer in abdominal surgery, the joint capsule in knee and
1 hip surgery or deep layers in back surgery.

2 For repair of tendons or other high tension structures in large orthopedic
5 surgeries.

Largest

Suture Type

There are many different types of suture, the two most important properties are...
Absorbable Vs Non-Absorbable
and
Braided Vs Non-Braided
The Vicryl suture pictured above is an example of a braided absorbable suture.

Absorbable Suture

Absorbable suture breaks down over time in the body. Examples of absorbable suture include Monocryl, Vicryl, Chromic, and PDS. The amount of time it takes a suture to break down in the body depends on a few factors such as suture type, size and the location it is placed. The list to follow includes the most common absorbable sutures in most operating rooms listed from shortest to longest break down time.
*Complete breakdown of strength times of various Ethicon Sutures:
Vicryl Rapide – 2 weeks
Undyed Monocryl – 3 weeks
Dyed Monocryl – 4 weeks
Coated Vicryl – 4 ½ weeks
PDS – 9 weeks
Panacryl – 70 weeks
Note – Suture absorption rates can increase in patients with fever, infection or protein deficiency. Also, the strength to a suture will decrease significantly prior to its complete breakdown time. Therefore a suture with higher tissue tension will have a greater chance of failure prior to the amount of time listed above

Non-Absorbable Suture

Nylon (Ethilon), Gortex, Silk, Fiberwire, Ethibond, Prolene and Steel are all example of non absorbable suture. When used on the skin, these sutures will be removed however when used in the body they will be retained inside the tissue.
Common uses for non absorbable suture:
Interrupted skin suturing when sutures will be removed later, 4-0 Nylon
Securing drains to skin, 2-0 Silk
Repair stitches for blood vessels, 6-0 Prolene
Vessel graft stitches for AAA, Fem-Pop or Carotid Artery grafts 5-0, 6-0 prolene or gortex
Bowel repair stitch, 3-0 silk
Achilles Tendon Repair, #5 Ethibond or Fiberwire

Braided or Non-Braided Suture

Braided suture have a number of strands woven together like a string. Examples of braided suture are; Silk, Vicryl and Ethibond. Non-Braided or Monofilament Sutures have a single strand such as Monocryl, PDS,and Ethilon Nylon.
Often times it will be surgeon preference when choosing a braided or non-braided suture. 4-0 vicryl and 4-0 monocryl are by far the most common sutures used from sewing the skin. Both are absorbable however vicryl is braided and monocryl is non-braided.
It is thought that non-braided sutures cause less reactivity in the body and are not as prone to becoming infected because they lack the grooves and rough surface for things to adhere. However non-braided sutures can have a greater tendency to loosen at the surgical knot with the lack of grip.

Suture Needles

Along with selecting the correct suture it is important as well to select an appropriate needle. The two factors in selecting a needle are size and if a cutting or tapered needle is needed.
While there are exceptions, much of the time you will find tapered needles are used inside the body such as on bowel, fascia, or muscle where the tissue is more easily pierced. Cutting needles are used for skin and very tough tissue such as bone and tendon.
Beyond choosing a cutting or tapered needle one only needs to select an appropriate size. There are hundreds of sizes and types of needles. Listed below are some of the most common used in most typical surgical procedures.

Tapered Suture Needles

TP or CTX – Used for closing fascia during abdominal surgery.
CT or CT1- For closing the joint space in knee and hip surgery or deep tissue layers after closing the fascia in general surgery.
CT2 - Often used on the uterus in OB Gyn procedures.
SH – Used to stitch the bowel or close layers of tissue in breast surgery.
CV or BV – Used for vessels and nerve repair, very small and delicate and often used with a Castro Viejo needle holder.

Cutting Suture Needles

FSLX - Large skin closure when a lot of tension is present common for retention sutures or large orthopedic use.
FSL – Often used for sewing in drains or skin closure needing higher tension closure.
FS2 or PS2 - For common skin closure.
P3 – Used for skin closure of small incisions such as hand surgery or facial plastic surgery.