sprl Docteur Michel Frère - Ligatures chirurgicales
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If a caesarian is a common surgical operation amongst many animals, then preserving the female’s fertility is at stake. Complications throughout surgery must be kept to a total minimum. It is the surgeon’s responsibility, within good surgical practice, to minimize the risk of infection and therefore choose the right suture material. From a technical point of view, the reduction of capillarity with the coating of braided multi-filaments, the development of monofilaments and absorbable synthetic sutures are an appreciable progress which help the surgeon in his quest to obtain quality.


The suture plays a large role in curing a wound. The material used and the type of suture vary depending on the tissue and organ.
Different types of sutures are distinguished according to their origin (natural…) and their capacity to absorb, or not, in the organism. Since the banning of Catgut in 2001 following a legislation concerning materials at risk of ESB, absorbable sutures are made from synthetic, as opposed to natural Catgut strings, or artificial (which result from a chemical transformation) materials.
The polymers’ structures obtained by synthesis may be very close to that of natural polymers, hence their advantages: properties, reliability and fabrication.
At the heart of absorbable sutures, the practitioner turns towards braided sutures known for their solid structure, or towards monofilament sutures historically better tolerated non capillary. Then, the practitioner turns towards the time of absorption rather than the actual composition of the thread. The braided sutures with standard absorption (60 to 90 days: Visorb, Glycofil, Vicryl , Vicryl+, Polysorb, The Dexon, Safil), or faster absorption (Vicryl Rapid…). Monofilaments with standard absorption may be found (About 100 days : Monocryl, Biosyn, Monosyn) or longer absorption (180 days: Monodox, PDSII, Maxon).
The choice of suture material must be meticulous, in keeping with required techniques, economic and good stocking conditions.


The rural practitioner who carries out caesarians is confronted with short and long term complications: breaking sutures, hemorrhages, “metrite ” , infections of the wound, peritonitis or, rarer still,  “clapier”.
Long-term, the female’s fertility is at risk.  In view of the fact that the time of absorption of a synthetic monofilament is relatively long like Monodox ( with bovines, the sutures used for uterine suture are still perceptible  to palpitation 60 days after the operation), one could think that fertility has been altered. However, 5 years experience from practitioners as well as numerous studies, confirm that no significant difference could be made in connection with Catgut.


Physiological Qualities

  1. Sterility: This is of prime importance!
  2. Tolerance
    It is mainly correlated with the suture size and material, but also its structure (braided or monofilament), its capillarity, coloring, the product’s coating and the procedures followed for conservation and sterilization. The ligature in the organism provokes a prolonged inflammatory reaction; the greater it is, resistance to infection is reduced and recovery is delayed.
    The referred to thread is steel which provokes practically no tissue reaction; the absorbable ligatures are inflammatory at various degrees.
    Allergic relations to the suture thread are specifically associated with chromic sutures.
  3. Absorption time
    This greatly depends upon the practitioner’s choice of type of ligature.
    The ligature should remain intact and keep the tissues closely in place throughout the whole time of healing, and even for a very long time in case of prosthesis. 
    After healing, its complete absorption is preferable not to leave a foreign body in the organism. The distinction absorbable/ non-absorbable is not absolute as there are absorbables which are long-term and non-absorbables which change in time (polyamide).
    Biomaterial absorbables are hydrolyzed by the organism generating pyruvic, lactic and glycolic acids, that are well known to the organism.
    This reaction does not depend on the animal’s general state of health, and is therefore constant and a function of the material used.

Physical qualities

  1. Capillarity
    Non-capillarity is the most sought quality for greater tolerance.
    It depends on the suture’s structure (a monofilament is non capillary) and its treatment (coating or impregnation with wax, silicones or hydrophobic resins to render braided sutures non capillary). The braided structure with slits encourages the extension of tissue liquids.
  2. Tensile Strength
    It must be high. The suture must resist to tension both during and after a surgical operation.
    Its knot tensile strength should be maximum so that the suture doesn’t break when severeal knots are made.
    The tensile strength depends on the material, the diameter and on the type of knot.
    When choosing suture material, the thread’s tensile strength should not exceed that of the tissue being sewn up. In descending order, the tensile strength is marked by a white line- more solid than all other biomaterial-, skin, aponevrosis, fascia, muscle, stomach, intestine, bladder, peritoneum and fat.
  3. Diameter
    The suture’s strength is proportional to the square of its diameter. In order to classify sutures, traditional USP numbering is used to refer to the thread’s resistance: a thread no. 1 is four times less resistant than a no. 4, a thread no. 3-0 is less resistant than a no. 0.
    Decimal numbering expresses the thread’s diameter, a decimal corresponds to 1/10th of a millimeter: a thread with a 0,2mm diameter is marked as decimal 2.
    The USP numbering is arbitrary and can be confusing: two threads with the same diameter and of different makes or of different nature may not have the same number. Decimal numbering, however, allows for approximation.
  4. Knot holding
    A surgeon only can appreciate it through the sliding loops and the solidity of the tightening. A suture is considered as “correct” if it holds out after three successive inversed knots. Good holding knots are more difficult to obtain with monofilaments and materials with minimal friction. Indeed, a knot’s solidity is defined by how much force is needed to make the thread slide. The knot is the weakest part of the suture.

Organoleptic qualities: the comfort of the practitioner’s work depends on them

  1. Sliding
    It depends on the braided material as well as the surface’s condition.
    In order to cause the least amount of trauma when penetrating the tissue, a good sliding is required. But for an easy manipulation and for a reliable suture, the ligature must not slide on the gloves both before and after tightening the knots.
  2. Suppleness
    Appreciated by the surgeon, knotting is rendered easy and so are delicate jobs. The suture used for its suppleness is silk. (natural braided non-absorbable). The suppleness depends on the material, the
    braiding: number, diameter and twist angle of the filaments making up the braided suture.
  3. Elasticity
    It depends on the braided material. The tightening of a knot is better to evaluate with a suture with no elasticity. But it is better to have a slight elasticity (Monosyn for example) to avoid necrosis.
  4. Visibility
    Coloring allows to see the suture on the operating area and the tissues, and to make the distinction between different sutures.
    The use of quality material is primordial to ensure the suture’s quality.
    Stocking conditions for the suture are very important to conserve physico-chemical properties.


It is in every vet’s interest to implement them, as an obligation of means and due to the legal impact arounf the use of sutures.

  1. Keep suture material in a place that is:
    - clean, with no antiseptics.
    - dry and , if needed, with a dessicant (silice gel)
  2. Keep the cassette properly closed, or the disposable blister in a specific package.
  3. Touch the material a little as possible: prefer cassette holders, disposable blisters.
  4. Avoid extreme temperatures. Heat causes the suture to become fragile, especially in humid conditions.
  5. Mark the opening date on the cassettes and only keep them for a period of 120 days in correct conditions; as soon as the stocking conditions are average (suture soaked in water during an operation, stocked in a dry and humid place…), they must be used within 15 days.
  6. Regularly check the solidity: all breaking of knots by hand necessitates new material
  7. Caring instructions: Clean the cassettes with a clean, dry cloth. If they are humid, allow them to dry in open air. Do not close them straight away in an air-tight box, unless you add a dessicant. Avoid bacterial contaminations of the suture in the cassette, favored by humidity and the blood.
  8. Hydrolyses of the suture is accelerated in acid or very basic areas (stomach, bladder…) Once started, it takes care of itself.
  9. During the summer period, when there are less operations, smaller quantity packaging can be preferred in 2,5 m or 5 m ( Monodox, Visorb, Safil C-set).


The range of synthetic absorbable sutures available gives each practitioner the possibility to opt for a reasonable solution depending on his needs, his work load and his preferences, all whilst guaranteeing a great technical security. But he must respect the guidelines for both the conservation and the use of such sutures.

Dr. Juliette Schmitt-Lemaitre
Equipment Products Manager


Braided Sutures
Laboratory Vetoquinol Vetoquinol Janssen Frère B-Braun Genia
Needle Suture x x x      
Cassette     x x x x
Reel x x   x x  
Absorption (Manufacturer’s
56 to 70 days 60 to 90 days 75 days 60 to 90 days 60 to 90 days 90 days
Composition Lactomer Polyglycolic acid Polyglatine Polyglycolic acid Polyglycolic acid Polyglycolic acid
Coating No Yes Yes Yes Yes Yes
Handling Good Correct to good Good Correct to good Correct to good Correct to good
Knot Security Good Correct to good Correct Correct to good Correct to good Correct to good
Memory Reduced Reduced Reduced Reduced Reduced Reduced
Tissue reaction Reduced to moderate Reduced to moderate Reduced to moderate Reduced to moderate Reduced to moderate Reduced to moderate
Usage All round, muscles Mostly conjonctive tissues, muscles. Also mouth, stomach, uterus... Internal sutures Internal sutures Internal sutures Internal sutures
Colour Purple Bicolor, beige Purple or natural Purple Purple Transparent


Laboratory Frère Janssen / B-Braun Vetoquinol Vetoquinol B-Braun Janssen
Needle Suture   x x x x x
Cassette x          
Reel x          
Absorption (Manufacturer’s
180 days 180 days 180 days 90 to 110 days 60 to 90 days 100 days
Composition Polydioxanone Polydioxanone Polyglyconate Glycomer Glycomer …Polyglecaprone
Handling Technique to master Technique to master Technique to master Good Technique to master Technique to master
Knot Security Technique to master Technique to master Technique to master Good Technique to master Technique to master
Memory High High High High Minimal Minimal
Tissue reaction Minimal Minimal Minimal Minimal Minimal Minimal
Usage Deep wound areas for longer support Deep wound areas for longer support Deep wound areas/tendons for longer support Digestive and urinary sutures All round Internal sutures
Colour Purple Purple Green or natural Natural Purple Purple, amber

Doctor Michel Frère, a rural practitioner for 22 years, answers the most frequently asked questions on his web site : see FAQ.


sprl Docteur Michel Frère - Ligatures chirurgicales - Route de la Belle-Vue, 17 - B-6833 Ucimont (Bouillon)
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